Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.
Institute of Child Health, University College London, 30 Guilford St, Holborn, London, WC1N 1EH, UK.
BMC Public Health. 2021 Mar 6;21(1):456. doi: 10.1186/s12889-021-10472-x.
Zambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth.
We carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013-14, and 2018). We calculated the percentage of women and men ages 15-24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months.
HIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20-24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30-1.84], among men; and aOR = 1.74 [1.40-2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32-1.88]) and in a union (aOR = 2.44 [1.83-3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82-17.19]). Education-based inequity was considerably widened among women than men by 2018.
HTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.
赞比亚是艾滋病毒负担最重的国家之一，年轻人受影响尤为严重。获得艾滋病毒检测和咨询（HTC）是减少艾滋病毒传播的关键步骤。本研究考察了 2007 年至 2018 年期间，年轻人获得 HTC 的情况、检测率的不平等以及接受 HTC 的决定因素发生的变化。
我们使用赞比亚三次人口与健康调查（2007 年、2013-14 年和 2018 年）进行了重复的横断面分析。我们计算了过去 12 个月中年龄在 15-24 岁的女性和男性中接受 HIV 检测的百分比。我们使用绝对不平等指标分析了 HTC 覆盖率的不平等情况。我们进行了单变量和多变量逻辑回归分析，以确定过去 12 个月中接受 HTC 的预测因素。
艾滋病毒检测率从 2007 年到 2018 年有所提高，孕妇中从 45%提高到 92%，非孕妇中从 10%提高到 58%，男性中从 10%提高到 49%。到 2018 年，大约 60%的年轻人在过去 12 个月中使用了政府卫生中心。到 2018 年，流动诊所成为第二大常见的检测来源，青少年男孩中有 32%接受了检测。在男性和非孕妇中进行的多变量分析表明，20-24 岁的人比青少年（男性的比值比[aOR]为 1.55[95%CI：1.30-1.84]；女性为 1.74[1.40-2.15]）接受检测的可能性更高。在男性中，接受割礼（aOR=1.57[1.32-1.88]）和已婚（aOR=2.44[1.83-3.25]）与增加检测的可能性相关。对于女性，更高的检测率与更高的教育程度有关（aOR=6.97[2.82-17.19]）。到 2018 年，与男性相比，女性的教育不平等程度大大扩大。
到 2018 年，赞比亚年轻人接受 HTC 的情况有了显著改善，分别有 65%和 49%的女性和男性在过去 12 个月中接受了检测。然而，要实现到 2020 年实现 95%的目标，需要维持通过政府卫生中心取得的成功，并扩大已被证明可以接受且有效的社区主导方法，以覆盖那些通过政府设施较难接触到的年轻男性和少女。
