The pooled prevalence of HIV testing in east Africa was 66.9% (95%CI; 66.70, 67.13%), which varies greatly from region to region. The regional variations in quality and access to HIV testing facilities as well as knowledge related to HIV / AIDS may be the reasons for the reported regional variations of HIV testing in eastern Africa [9, 14]. The prevalence reported in this study was in line with the report in Kenya . The finding in this study was greater than the study conducted elsewhere [3, 16, 23] and it was smaller than reports from different studies [9, 10]. The observed variations in the prevalence of HIV testing might be explained by cultural beliefs and lifestyle differences across regions . Besides, the discrepancy might be due to the difference in quality and accessibility of HIV testing facilities [9, 14, 24, 25].
In this study age of respondent, multiple sexual partnerships, marital status, visiting health facility, stigmatized attitude towards HIV/AIDS, HIV knowledge, risky sexual behavior, residence, educational level, wealth status, age at first sex, and community illiteracy level were significant factors associated with HIV testing.
The odds of HIV testing was higher among married women compared with their counterpart. This finding was in agreement with the study done in Ethiopia . This might be due to compulsory counseling and testing promotion for couples intending to get married by different organizations including religious groups . Women who visit health care facilities had higher odds of being tested for HIV, which was supported by another study . This might be because health professionals initiate people who visited health facilities for HIV testing .
In this study women from higher socioeconomic status had lower odds of being tested for HIV, which is contrary to another study . This is justified by being rich may be associated with a greater awareness of risks and with reduced financial barriers to testing . Women with primary and above educational levels had a higher chance of being tested for HIV, which is supported by different studies [16, 27]. The reason for this discrepancy might be as education can improve HIV knowledge as well as empowers women to make decisions to visit the health facility and use health services .
Women who had multiple sexual partners had less chance of being tested for HIV compared with their counterparts. However, the finding of this study was in contrast to another study . This difference might be associated with individuals with a history of multiple sexual partnerships who might be fear of having HIV and have no interest to know their status. The study at hand revealed that women with higher and comprehensive knowledge about HIV had higher odds of being tested for HIV. This is supported by a study conducted in South Africa . Different studies reported people with higher HIV-associated stigma scores had less chance of being tested for HIV. This is explained as people could be hesitant to test because the disclosure of a positive HIV test result may lead to loss of friendship, family relations, jobs and housing and health care due to stigmatization [2, 18, 22]. However, in the present study people with stigmatized attitudes had a higher chance of being tested for HIV and this might be explained by the variation in the cultural and socioeconomic status of the population included in this study.
In this study, women with risky sexual behavior had higher odds of being tested for HIV. This is supported by another study . Individuals with risky sexual behavior live under persistent fear and uncertainty about their serostatus and are usually suspicious and worried that they might have infected with HIV. This urges them to develop habits of seeking VCT service .
Individuals who initiated sex early had a higher chance of being tested for HIV and this is supported by the study conducted in Malawi . This might be explained as early age at first sexual intercourse is associated with a higher risk of acquiring the different sexually transmitted disease and risky sexual behaviors that may lead to a higher risk for HIV infection, which in turn enforce them to know their HIV status .
Women from rural dwellers had lower odds of being tested for HIV, which was supported by the study conducted in Ethiopia . This may be justified by the better availability and accessibility of HIV testing facilities in urban settings compared with rural [30, 31]. Women from communities with higher illiteracy levels had less chance of being tested for HIV. This finding was supported by studies conducted in Ethiopia and Zambia [10, 16]. This might be associated with educational attainment may increase uptake of testing through increased recognition of the importance of knowing one’s HIV status [20, 32].
Strength and limitation of the study
The study was based on weighted nationally representative data from 11 eastern African countries with a large sample size. Also, the analysis used the multilevel analysis to accommodate the hierarchical nature of the DHS data. Moreover, since it is based on the national survey data, the study has the potential to give insight for policy-makers and program planners to design appropriate intervention strategies both at the national and regional levels. However, this study had limitations in that the DHS survey was based on respondents’ self-report, this might have the possibility of recall bias. Besides, since this study was based on cross-sectional collected DHS data, we are unable to show the temporal relationship between HIV testing and independent variables.