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Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa

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Understanding HIV testing determinants in different settings is vital to reducing new infections. This study assessed HIV testing rates during antenatal care (ANC) in seven sub-Saharan African countries designated as high, medium, low or no conflict intensity settings. We ranked and plotted concentration curves for HIV testing by socioeconomic inequality and determined their concentration indices (CCI). Testing for HIV during ANC was highest in Zimbabwe (95.7%) and lowest in Sudan (3.6%). Countries with medium and high conflict intensity experienced higher HIV testing inequality (CCI = 0.38) than countries with low or no conflict (CCI = 0.15). Low HIV testing rates were associated with no education, rural areas, poorest wealth index quintiles and home birth, which demonstrate that determinants of HIV testing during ANC in conflict-affected areas are complex and context-based. Programme implementation and policymakers must acknowledge these complexities and local contexts in their program designs and planning.

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The data is available from UNICEF on request.

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The authors thank UNICEF for the permission to use their data in this study.


No funding was received for conducting this study.

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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by WM. The first draft of the manuscript was written by WM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to William Mude.

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The authors have no relevant financial or non-financial interests to disclose.

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The data used in this article utilized Multiple Indicator Cluster Survey (MICS) that was accessed via the UNICEF website upon request, which provides de-identified data. This study was reviewed and deemed exempt by our Human Research Ethics Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study by UNICEF.

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Mude, W., Nyanhanda, T. Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa. AIDS Behav 26, 1587–1596 (2022).

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