Trends and Factors Associated with HIV Testing among Adolescent Girls and Young Women in Lesotho: Results from 2004 to 2014 Lesotho Demographic and Health Surveys

Abstract

HIV/AIDS is prevalent among adolescent girls and young women (AGYW) in Lesotho, and among the top five infectious diseases causing a high mortality rate in Africa. The paramount management of HIV is based on screening, prevention, and therapeutic interventions, of which HIV testing and counselling (HTC) is the gateway. The utilization of HTC services among AGYW is limited owing to numerous barriers encountered by this population group. The aim of this study was to assess trends and factors associated with HTC among AGYW in Lesotho. A secondary data analysis was used to analyze data sets extracted from the 2004, 2009, and 2014 Lesotho Demographic Health Surveys (LDHS). The LDHS was conducted using a cross-sectional study design and samples drawn were representative of the whole population of Lesotho. We used descriptive analysis to determine trends in HTC. In determining factors associated with the uptake of HTC, univariate and multivariable logistic regression models were applied on the 2014 LDHS. All analyses were adjusted for unequal sampling probabilities using survey weights. The number of AGYWs analyzed were 2743 in 2004, 2393 in 2009, and 2842 in 2014. The overall prevalence estimates of HTC uptake were 12%, 62.2%, and 72.5%, respectively. For the 15–19 years AGYW, HTC uptake rose from 6.2% (2004), 46.3% (2009), to 57.9% (2014), while for the 20–24 years age group, the rates were 18.7%, 80.2%, and 88.3%, respectively. For the 2842 AGYW in 2014, the odds of ever having an HIV test were significantly higher for those aged 20–24 years (aOR 2.15, 95% CI 1.61 to 2.87, p < 0.001), in a union (aOR 3.21, 95%CI 2.25 to 4.58, p < 0.001), with Mother-to-child transmission of HIV (MTCT) knowledge (aOR 1.53, 95%CI: 1.21 to 1.94, p < 0.001), with HIV non-discriminatory attitudes (aOR 2.50, 95%CI 1.87 to 3.34, p < 0.001), and those who had ever been pregnant (aOR 11.53, 95%CI 7.46 to 17.84, p < 0.001). HTC uptake among AGYW in Lesotho is below expected targets, hence we recommend optimizing access to HTC services, especially for AGYW aged 15–19 years.