Wingston Ng�??ambi1*, Isabel Kazanga Chiumia1, Newton Chagoma, Joseph Mfutso-Bengo
Introduction: Malawi is on track to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets with the current performance estimated at 91-83-90 against the UNAIDS targets. However, there is need to further understand the socio-demographic characteristics of persons likely to access HIV Testing and Counselling Services (HTS), the entry point into the UNAIDS 90-90-90 cascade. Methods: This study used secondary data from the Malawi Demographic Health Survey (MDHS) collected between 2004 and 2016. MDHS is a representative cross-sectional survey. The predictor variables included: sex, age, survey year, and region of residence, district of residence, education status, occupation and socio-economic position. Of HIV testing uptake was the primary outcome of this study. Data was analysed using STATAv16.0. Multiple logistic regressions were conducted to determine significant predictors of HTS uptake. Statistical significance was set at P<0.05. Results: A total of 37829 persons were studied. There was increasing trend in the proportion of persons with HIV testing uptake from 18.4% in 2004/5 to 90.4 % in 2015/16. Multiple logistic regression showed that females were almost three times more likely to go for HTS compared to males (adjusted odds ratio (AOR)=2.52; 95%CI:2.34-2.72; P<0.001). Increasing age and education level were associated with increased likelihood of seeking HTS. Individuals in professional employment were more likely to have an HIV test compared to those in informal employment (AOR=1.21; 95%CI: 1.11-1.33, P<0.001). Individuals with rich socio-economic position (SEP) had higher likelihood of HIV testing than those in poor SEP (AOR=1.10 (95%CI: 1.02-1.18), P=0.01). There was both spatial and temporal increasing trend in the HTS uptake between 2004 and 2016. Conclusion: There has been an increase in spatial and temporal trends in HTS uptake in Malawi. However, inequalities in HTS uptake still exists especially for those in the informal employment and individuals deemed to have low SEP in the society having lower uptake of HTS. The Malawi HIV programme should implement targeted interventions for sub-groups left behind and also optimize provision of HTS services in order to close the gaps in accessing HTS and consequently maximizing universal uptake of HTS
