ArticleBMJ public health2026
Wealth-related inequalities in HIV testing and counselling during antenatal care among reproductive age women in Ethiopia: a decomposition analysis.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: HIV testing and counselling (HTC) during antenatal care (ANC) is an essential intervention to prevent HIV transmission from mother to child. Despite its significance, disparities in access to and utilisation of HTC during ANC remain a persistent public health challenge in Ethiopia. Wealth-related inequalities have been identified as a major barrier to achieving equitable access to HTC services. However, wealth-related inequalities in HTC during ANC are not explored in Ethiopia. This study aims to assess the magnitude of wealth-related inequalities in HTC during ANC and its contributing factors in Ethiopia. Methods: We analysed the 2016 Ethiopia Demographic and Health Survey dataset, collected through a cross-sectional design. Descriptive statistics were used to summarise sociodemographic characteristics. The Erreygers Normalised Concentration Index (ECI) was used to assess the inequalities in HTC during ANC. Results: The coverage of HTC during ANC was 19.1%. The weighted ECI for HTC during ANC was 0.18 with an SE=0.02 (p<0.05). Wealth (39%), media exposure (10.9%) and religion (11.2%) were major contributors to the inequalities in HTC during ANC, while education (6.7%) and comprehensive knowledge of HIV (4.9%) also played notable roles. Additional factors such as residence (1.1%) and region (0.6%) demonstrated smaller but significant contributions to the inequality observed in HTC during ANC. Conclusion: There is wealth-related inequality in HTC during ANC in Ethiopia; the poor households had disproportionately lower utilisation than the richer households. Wealth, media exposure and religion were major contributors to the inequality observed in HTC during ANC. Policy-makers should focus on improving access to HTC services for socioeconomically disadvantaged women by increasing awareness through media campaigns and working with religious leaders.
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