Prevalence and factors associated with knowledge of HIV Self-Test kit and HIV-Self Testing among Ghanaian women: multi-level analyses using the 2022 Ghana demographic and health survey.

backgroundThe Ghana AIDS Commission reported in 2022 that out of 354,927 people living with HIV, 67.5% were females. While considerable progress has been made in expanding access to HIV testing services, a significant proportion of individuals remain unaware of their HIV status, presenting a significant barrier to effective prevention and treatment. Although HIV Self-Testing (HIVST) has emerged as a promising approach to increase the uptake of HIV testing, its adoption and utilisation have been limited by various sociodemographic factors. We investigated the knowledge of HIV Self-Testing Kit as well as prevalence of HIVST and their associated factors among Ghanaian women.

methodsThis was a cross-sectional study among 15,014 women of their reproductive age using data from the 2022 GDHS. The data were analysed using STATA version 17.0. Simple frequencies were used to summarise the data. A multilevel binary logistic regression using four models (Models I-IV) was used to examine the association between the two outcome variables and the explanatory variables, controlling for individual- and contextual-level factors. Statistical significance was set at p < 0.05 at 95% CI.

resultsWe discovered that only 18.2% [95% CI = 17.1-19.3] and 2.4% [95% CI = 2.1-2.8] of Ghanaian women in their reproductive age had adequate knowledge of HIV Self-Testing Kit (HIVSTK) and had used the HIVSTK for HIV testing respectively. The odds of knowledge of HIVSTK were higher among women aged 20-24 years (aOR = 1.33, 95% CI = 1.07, 1.64; p = < 0.01), those with a higher level of education (aOR = 6.14, 95% CI = 4.41, 8.55; p < 0.001), those who listen to radio (aOR = 1.41, 95% CI = 1.20, 1.65; p < 0.001) and use the internet at least once a week (aOR = 1.49, 95% CI = 1.24, 1.78; p < 0.001). The odds of knowing about HIVSTKs increased with higher levels of wealth distribution with the highest recorded among those in the wealthiest group (aOR = 1.85, 95% CI = 1.32, 2.58; p < 0.001). Compared with women with no formal education, the odds of HIVST were higher among those with higher education (aOR = 20.29, 95% CI = 9.16, 44.97; p < 0.001). The odds of HIVST were also higher among those who listen to radio (aOR = 1.51, 95% CI = 1.05, 2.17; p < 0.05) and those who use the internet at least once a week [aOR = 1.80, 95% CI = 1.15, 2.83; p < 0.001). Furthermore, the odds of self-testing for HIV were higher among women with a history of HIVST (aOR = 6.73, 95% CI = 3.34, 13.55; p = < 0.001) and those with the wealthiest wealth quintiles (aOR = 4.31, 95% CI = 1.31, 13.02; p = < 0.001).

conclusionOur study revealed a shallow knowledge of HIV Self-Testing Kit as well as a low prevalence of HIV self-testing among women in their reproductive age in Ghana. The evidence suggests that more than nine in ten women had never undertaken an HIV self-test. The observed HIVST in this study may have implications for achieving the objectives of the HIVST policy. This may impede the achievement of SDG 3.3 which seeks to end the AIDS epidemic by 2030. Practical strategies including education and awareness, may be utilized through electronic media as well as radio and television, especially among those with little or no education. Additionally, the government can subsidise testing kits to create opportunities for those in the low-wealth quintiles to purchase and self-test themselves.