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Title
Knowledge of HIV-positive status among adult people living with HIV (PLHIV) in Swaziland: A population-based survey
Presenter
Munyaradzi Pasipamire
Authors
M. Pasipamire1, T.T. Ao2, S. Mazibuko2, F. Mhlanga3, L. Dube1, Z. Mnisi4, H. Nuwagaba-Biribonwoha5, C. Draghi6, N.M. Philip5, K. Brown6
Institutions
1Ministry of Health, Swaziland National AIDS Programme, Mbabane, Swaziland, 2Division of Global HIV and TB, Center for Global Health, CDC Swaziland, Mbabane, Swaziland, 3Central Statistics Office, Government of the Kingdom of Swaziland, Mbabane, Swaziland, 4Ministry of Health, Government of the Kingdom of Swaziland, Mbabane, Swaziland, 5ICAP- Columbia University, New York, United States, 6Division of Global HIV and TB, Centre for Global Health, CDC, Atlanta, United States

Background: HIV testing is the entry point to HIV prevention and treatment. The Joint United Nations Programme on HIV/AIDS set the 90-90-90 targets with the first-90 expecting 90% of PLHIV to know their status by 2020. Swaziland has 220,000 PLHIV but lacks a population-based first-90 estimate. Therefore, we used the 2016-17 Swaziland HIV Incidence Measurement Survey2 (SHIMS2) to describe and determine factors associated with knowledge of HIV-positive status (awareness/aware).
Methods: Completed in 2017, SHIMS2 was a cross-sectional, nationally representative, and population-based, two-stage randomized cluster-sampled household survey. Interviews and rapid HIV testing were conducted on adults aged ≥15 years. Using weighted Jackknife survey data in Stata 14, frequencies, weighted proportions, Chi-square and logistic regression analyses were conducted. Potential factors were analyzed in two blocks, namely socio-demographic and behavioral. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) were reported.
Results: Of the 13,339 adults, 10,934 (81.97%) responded to the HIV-testing questionnaire, with 2,031 (32.51%) females and 972 (20.39%) males confirmed HIV sero-positive. Among those confirmed, 1,811 (88.56%) females and 776 (77.46%) males knew their HIV-positive status (p-value(p)< 0.001).
Awareness was less likely among those reporting no condom usage compared to those who used condoms at last sexual encounter within the preceding year in both females (aOR=0.48 (95% CI:[0.34-0.67]),p< 0.001) and males (aOR=0.33 [0.22-0.50],p< 0.001). Awareness was more likely in females (aOR=5.26 [2.75-10.05],p< 0.001) and males (aOR=2.65 [1.58-4.44],p< 0.001) reporting previous tuberculosis-clinic visits compared to those reporting no previous visits. Among females, awareness was more likely in those aged 25-49 years compared to those 15-24 (aOR=2.23 [1.53-3.26],p< 0.001), and those reporting previous antenatal-clinic visit (aOR=1.76 [1.20-2.58], p=0.004) compared to those reporting no previous visits. Awareness increased with increasing number of pregnancies (see Table). Among males, awareness was more likely among those aged 25-49 (aOR=2.16 [1.19-3.91], p=0.012) and 50+ (aOR=3.88 [1.75-8.57], p=0.001), compared to those aged 15-24 years. Awareness was more likely among married (aOR=2.09 [1.38-3.16], p=0.001) and divorced (aOR=2.32 [1.26-4.26], p=0.007) men compared to never married men.


Table: Multivariate analysis of factors affecting awareness of HIV positive status among adults aged 15+
[Table: Multivariate analysis of factors affecting awareness of HIV positive status among adults aged 15+]


Conclusions: In Swaziland, females are close to reaching the first-90 whilst males are >10% behind. Providing male-friendly, male-targeted services may unlock more testing opportunities required to bridge this gap.

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