Inequalities in the provision of rapid HIV testing in primary health care: ecological study, Paraná, 2013-2023.

Objective: To analyze temporal trends, spatial distributions, and factors associated with the provision of rapid HIV testing in primary health care in Paraná, between 2013 and 2023. Methods: Ecological study using data from the Outpatient Information System ( Results: During the period, 385,960 tests were recorded, of which 89.1% were performed by nurses. The state mean was 30.79 tests per 10,000 inhabitants, with emphasis on the Western macroregion (86.66 per 10,000 inhabitants). Some regions, such as Cornélio Procópio, showed marked growth (annual percentage change [APC] 71.19; 95% confidence interval [95%CI] 55.54; 205.09). Spatial analysis indicated a concentration of municipalities with higher testing rates in the Pato Branco, Francisco Beltrão, and Foz do Iguaçu regions. The illiteracy rate (rate ratio [RR] 0.77; 95%CI 0.63; 0.93), prenatal care coverage (RR 1.20; 95%CI 1.04; 1.37), and detection of acquired syphilis (RR 1.33; 95%CI 1.11; 1.59) were associated with the provision of rapid testing. Conclusion: Testing showed growth over the study period, though uneven across regions and marked by municipal heterogeneity. Socioeconomic, epidemiological, and programmatic factors influenced performance, indicating the need for targeted policies to reduce inequalities and strengthen primary health care in HIV diagnosis.