Spatial variation in HIV test non-uptake among antenatal care–attending pregnant women in sub-Saharan Africa: a cross-sectional study using demographic and health survey data

Abstract

OBJECTIVES: This study assessed the spatial distribution of HIV test non-uptake among pregnant women who attended antenatal care (ANC) in sub-Saharan Africa. DESIGN: Cross-sectional study design. SETTING: Sub-Saharan Africa (SSA) region. 24 SSA countries were included in this study. DATA SOURCE: Demographic and Health Survey (DHS), 2016-2024. PARTICIPANTS: 82 397 women who were pregnant in the last 2 years preceding the survey. OUTCOME MEASURE: HIV test non-uptake, which is a legacy indicator of HIV test among pregnant women. RESULT: The HIV test non-uptake among ANC attending pregnant women was 39.6% (95% CI 39.27% to 39.93%). The spatial autocorrelation test revealed that HIV testing non-uptake among pregnant women was clustered. The global Moran's I value was 0.48 with a p value <0.01. Hotspot areas were those with high rates of HIV testing non-uptake. These hotspot areas were located in most parts of Mali, Mauritania, Madagascar, Guinea, Senegal, central parts of Angola, eastern part of Senegal and northern parts of Ethiopia. The Multiscale Geographical Weighted Regression (MGWR) model explained 91% of the spatial variation of HIV test non-uptake among pregnant women, who were in the age group 15-19 years, had no formal education and no health insurance, and less than four antenatal care contacts were significantly associated with HIV test non-uptake. CONCLUSION: There was a significant geographical variation in HIV test non-uptake among pregnant women attending antenatal care (ANC) in sub-Saharan Africa. Prioritising hotspot areas with high rates of HIV test non-uptake for spatially targeted interventions is essential. Policymakers, health professionals, and other stakeholders should focus on improving women's formal education, expanding health insurance coverage, and increasing ANC contacts to ensure that each visit includes HIV screening. Moreover, special attention should be given to younger women to enhance HIV testing uptake among those attending ANC in sub-Saharan Africa.