Abstract Body

Awareness of HIV-positive status is critical to contain the epidemic. We assessed characteristics associated with HIV awareness in adults living with HIV (ALWH) (15-59 years) and reasons for not getting tested, using Population-based WHIV Impact Assessment (PHIA) surveys conducted by ministries of health of each country in collaboration with ICAP and CDC.

Consenting adults from randomly selected households in 12 African countries provided demographic and behavioral information and blood samples for HIV testing (Table). We applied multivariable Poisson regression with robust error variance. Variances were estimated via the Jackknife series.

Among 239,678 adults, 15,579 (6.5%) were ALWH. Percent awareness of HIV infection ranged from 50.2% in Cote d’Ivoire to 86.8% in Eswatini. Multivariable regression results indicated that men overall and young men and women aged 15-24 years old were less likely to be aware of their HIV-positive status across all countries. Percent of unaware ALWH who had ever tested for HIV ranged from 46.7% (95% CI: 36.7%-56.7%) in Cote d’Ivoire to 81.7% (95% CI: 78.0%-85.4%) in Lesotho. Male sex, younger age, rural residence, and lower education level were associated with lower HIV testing prevalence. Among the subset who tested previously, no more than half (ranging from 21%, in Cote d’Ivoire to 51%, in Eswatini) had tested in the 12 months prior to the survey.

In a large randomly selected cohort of ALWH, a substantial percent in several African countries were unaware of HIV infection, particularly men and young adults. Low frequency of recent testing was noted, with data supporting the need for focused and ongoing testing services for youth, males, those with lower educational achievement, and those living in rural areas.