Frequency of HIV-testing and factors associated with multiple lifetime HIV-testing among a rural population of Zambian menReport as inadecuate

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BMC Public Health

, 15:960

First Online: 24 September 2015Received: 13 April 2015Accepted: 11 September 2015DOI: 10.1186-s12889-015-2259-3

Cite this article as: Hensen, B., Lewis, J., Schaap, A. et al. BMC Public Health 2015 15: 960. doi:10.1186-s12889-015-2259-3


BackgroundAcross sub-Saharan Africa, men-s levels of HIV-testing remain inadequate relative to women’s. Men are less likely to access anti-retroviral therapy and experience higher levels of morbidity and mortality once initiated on treatment. More frequent HIV-testing by men at continued risk of HIV-infection is required to facilitate earlier diagnosis. This study explored the frequency of HIV-testing among a rural population of men and the factors associated with more frequent HIV-testing.

MethodsWe conducted a secondary analysis of a population-based survey in three rural district in Zambia, from February-November, 2013. Households N = 300 in randomly selected squares from 42 study sites, defined as a health facility and its catchment area, were invited to participate. Individuals in eligible households were invited to complete questionnaires regarding demographics and HIV-testing behaviours. Men were defined as multiple HIV-testers if they reported more than one lifetime test. Upon questionnaire completion, individuals were offered rapid home-based HIV-testing.

ResultsOf the 2376 men, more than half 61 % reported having ever-tested for HIV. The median number of lifetime tests was 2 interquartile range = 1-3. Just over half n = 834; 57 % of ever-testers were defined as multiple-testers. Relative to never-testers, multiple-testers had higher levels of education and were more likely to report an occupation. Among the 719 men linked to a spouse, multiple-testing was higher among men whose spouse reported ever-testing adjusted prevalence ratio = 3.02 95 % CI: 1.37-4.66. Multiple-testing was higher in study sites where anti-retroviral therapy was available at the health facility on the day of a health facility audit. Among ever-testers, education and occupation were positively associated with multiple-testing relative to reporting one lifetime HIV-test. Almost half 49 % of ever-testers accepted the offer of home-based HIV-testing.

DiscussionReported HIV-testing increased among this population of men since a 2011-12 survey. Yet, only 35 % of all men reported multiple lifetime HIV-tests. The factors associated with multiple HIV-testing were similar to factors associated with ever-testing for HIV. Men living with HIV were less likely to report multiple HIV-tests and employment and education were associated with multiple-testing. The offer of home-based HIV-testing increased the frequency of HIV-testing among men.

ConclusionAlthough men-s levels of ever-testing for HIV have increased, strategies need to increase the lifetime frequency of HIV-testing among men at continued risk of HIV-infection.

AbbreviationsHIVHuman Immunodeficiency Virus

HTCHIV testing and counselling

ARTAnti-retroviral therapy

CRTCluster randomised trial

BHOMABetter Health Outcomes through Mentoring and Assessment

PDAsPersonal digital assistant

DHSDemographic and Health Surveys

SEPSocioeconomic position


PCAPrincipal components analysis

PRPrevalence ratio

adjPRAdjusted prevalence ratio

LRTLikelihood ratio test

ICCIntra-cluster correlation

IQRInterquartile range

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Author: B. Hensen - JJ Lewis - A. Schaap - M. Tembo - M. Vera-Hernández - W. Mutale - HA Weiss - J. Hargreaves - JSA Stringer -


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