A Multilevel Modeling Analysis of the Determinants and Cross-regional Variations of HIV Testing in Ethiopia: Ethiopian DHS 2011

Abstract

Background: Determinants of HIV testing can be affected at both individual and community levels but most studies in Ethiopia did not assume any clustering effect hence the estimates will often be biased. Methods: Given the hierarchical nature of the survey population, that is; Ethiopian Demographic and Health Survey (EDHS2011), multilevel modeling approach was used. Results: About 4.07% (6.68%) of the total variation on ever being tested for HIV was attributable to region-level factors and 17.27% (18.45%) was attributable to cluster level factors among men (women) respectively. Conclusion: Random effects are useful for modeling intra-cluster correlation; that is, observations in the same cluster were correlated because they share common cluster-level random effects. This study hence will help to notify national efforts targeting on specific population who mostly under-utilized HIV testing services as well as to identify key geographic areas for further investigation. In line with this, the strengthening of the health programs on advocating the benefits of HIV testing through mass media, integrating family planning services with HIV testing, concentrating on both men and women in the age groups of 20 to 34 years old, targeting on Somali region and Nuwer ethnic group while designing services would greatly improve the proportion of HIV testing. Moreover, efficient distribution of health care facilities offering HIV testing services among women urban and rural areas residents are required.