Geospatial and multilevel analysis of lifetime HIV testing uptake among high-risk adults in Mozambique: evidence from the 2022-2023 DHS.

BACKGROUND

HIV testing is a critical entry point for prevention and treatment, yet disparities in uptake persist among high-risk populations in Mozambique. This study investigates the prevalence, spatial distribution, and determinants of lifetime HIV testing among high-risk adults aged 15-49 using 2022-2023 DHS data.

METHODS

A cross-sectional analysis of 15,393 high-risk adults was conducted. Descriptive statistics, spatial analyses (Moran's I, hotspot analysis, Kriging interpolation, SaTScan), and multilevel logistic regression models were applied to identify individual- and community-level factors associated with HIV testing uptake. We estimated the weighted prevalence of lifetime HIV testing uptake. Adjusted odds ratios (AORs) with 95% confidence intervals were reported to measure the association between explanatory variables and HIV testing uptake, while statistical significance was determined using p-values < 0.05.

RESULTS

Overall, 63.7% of high-risk adults had ever tested for HIV. Testing uptake was higher among females (66%) than males (57%), and among urban (76%) versus rural residents (56%). The highest testing rate was in the 25-34 age group (78%) and lowest among adolescents 15-19 years (31%). Wealth, education, marital status, employment, media exposure, and HIV knowledge positively influenced testing. Significant regional disparities were observed, with southern provinces (Maputo City 87.7%) showing higher uptake than northern and central provinces (Zambezia 44.9%). Spatial analysis confirmed strong clustering (Moran's I = 0.78, p < 0.001), identifying low-testing hotspots in northern and central rural areas. Multilevel modeling showed individual and community factors explained 62.9% of between-cluster variance, with females (AOR = 2.39), higher education (AOR = 6.44), marriage (AOR = 4), and urban residence (AOR = 1.58) significantly increasing odds of testing.

CONCLUSION

HIV testing uptake in Mozambique remains uneven across socio-demographic and geographic groups. Targeted and equity-focused interventions are needed to expand testing among adolescents, men, rural populations, and residents of northern and central provinces. Strengthening community-based testing services, improving health education, and addressing geographic barriers will be essential for accelerating progress toward national HIV control targets.