Trends and Determinants of HIV Testing Uptake among Men Aged 15–59 Years in Zambia: A Multilevel Analysis of the Zambia Demographic and Health Surveys, 2007–2024

Abstract

Abstract HIV testing remains the primary entry point to HIV prevention, treatment, and care. Although Zambia has made substantial progress in its HIV response, men remain less consistently reached by HIV testing services. This study assessed trends and determinants of HIV testing uptake among men aged 15–59 years in Zambia using repeated nationally representative survey data. We pooled men’s data from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013/14, 2018, and 2024. The outcome was HIV testing uptake, defined as ever tested for HIV and received results (DHS variable mv781). Analyses accounted for the complex survey design using sampling weights in Stata 14.2. Trends were examined using weighted proportions and design-adjusted chi-square tests. Determinants were assessed using multilevel logistic regression with men nested within clusters, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). HIV testing uptake increased markedly from 20.7% (2007) to 62.9% (2013/14) and peaked at 77.4% (2018), with a modest decline in 2024 (73.5%); differences across survey years were statistically significant (p<0.05). In the fully adjusted model, survey year remained a strong predictor of testing compared with 2007 (2013/14 AOR 6.91, 95% CI 5.62–8.49; 2018 AOR 13.85, 95% CI 11.21–17.12; 2024 AOR 7.24, 95% CI 5.86–8.95). Older age was associated with higher odds of testing (25–34 AOR 3.51; 35–49 AOR 3.08; 50–59 AOR 1.65 vs 15–24). Rural residence was associated with lower testing (AOR 0.82, 95% CI 0.72–0.93). Higher education showed a strong gradient (primary AOR 1.55; secondary/higher AOR 4.19 vs none). Married men (AOR 4.33, 95% CI 3.56–5.27) and employed men (AOR 1.32, 95% CI 1.17–1.49) had higher odds of testing. Significant regional differences persisted after adjustment. HIV testing uptake among men in Zambia rose substantially from 2007 to 2018 and remained high in 2024, though gaps persisted among younger men, rural residents, and selected provinces. Targeted, male-friendly strategies especially for younger and rural men and geographically tailored programming are needed to sustain gains and reduce inequities in HIV testing.