{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:15:42Z","timestamp":1783570542205,"version":"3.55.0"},"reference-count":32,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T00:00:00Z","timestamp":1702080000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003323","name":"Agence Nationale de Recherches sur le Sida et les H\u00e9patites Virales","doi-asserted-by":"publisher","award":["ANRS-12377 B104"],"award-info":[{"award-number":["ANRS-12377 B104"]}],"id":[{"id":"10.13039\/501100003323","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,10,31]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aim to explore spatial variations in socioeconomic inequalities in HIV testing uptake in sub-Saharan Africa (SSA) at different geographical scales to identify potential geographical hotspots of inequalities. Additionally, to evaluate the potential benefits of HIV testing programmes, we assess whether local levels of HIV testing match the local levels of HIV prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multi-country analysis of population-based cross-sectional surveys in SSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We analysed data from 25 SSA countries with Demographic and Health Surveys between 2011 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Country-level analysis included 473\u2009775 participants (312\u2009104\u2009women and 161\u2009671 men) and cluster-level analysis included 328\u2009283 individuals (241\u2009084\u2009women and 87\u2009199 men). Women aged 15\u201349 years and men aged 15\u201354\/59 years in selected households who were tested for HIV in the last 12 months were eligible. We quantified inequalities in self-reported recent HIV testing with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) across geographical scales to capture sex-specific within-country spatial variations. We also conducted local Getis-Ord Gi* statistics to consider the autocorrelation in fine-scale SII and RII across countries. To assess the efficiency of HIV testing programmes, we measured the correlation between recent HIV testing and HIV prevalence through Spearman correlation across geographical scales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We observed varying inequalities in recent HIV testing in magnitude and spatial distribution on both absolute and relative scales in many countries for both sexes at national and subnational levels. Hotspots of absolute and relative inequalities were mostly observed in Western and Central Africa with a few regions in Eastern and Southern Africa. Despite significant sex-specific correlations between testing and prevalence in all countries when assessed at the national level, we report an absence of such a correlation at fine scale in 17 of 50 sex-country combinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We highlight the importance of investigating the spatial variability of various HIV indicators and related inequalities across different geographical levels. Results may help inform an equitable distribution of HIV testing services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072403","type":"journal-article","created":{"date-parts":[[2023,12,11]],"date-time":"2023-12-11T16:20:43Z","timestamp":1702311643000},"page":"e072403","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Investigating inequalities in HIV testing in sub-Saharan Africa: spatial analysis of cross-sectional population-based surveys in 25 countries"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-0817","authenticated-orcid":false,"given":"Pearl Anne","family":"Ante-Testard","sequence":"first","affiliation":[{"name":"Laboratoire MESuRS, Conservatoire National des Arts et M\u00e9tiers, Paris, \u00cele-de-France, France"},{"name":"Unit\u00e9 PACRI, Institut Pasteur, Conservatoire National des Arts et M\u00e9tiers, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Carrasco-Escobar","sequence":"additional","affiliation":[{"name":"Health Innovation Laboratory, Institute of Tropical Medicine \u201cAlexander Von Humboldt\u201d, Universidad Peruana Cayetano Heredia, Lima, Peru"},{"name":"Scripps Institution of Oceanography, University of California, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Benmarhnia","sequence":"additional","affiliation":[{"name":"Scripps Institution of Oceanography, University of California, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Temime","sequence":"additional","affiliation":[{"name":"Laboratoire MESuRS, Conservatoire National des Arts et M\u00e9tiers, Paris, \u00cele-de-France, France"},{"name":"Unit\u00e9 PACRI, Institut Pasteur, Conservatoire National des Arts et M\u00e9tiers, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6462-7185","authenticated-orcid":false,"given":"K\u00e9vin","family":"Jean","sequence":"additional","affiliation":[{"name":"Laboratoire MESuRS, Conservatoire National des Arts et M\u00e9tiers, Paris, \u00cele-de-France, France"},{"name":"Unit\u00e9 PACRI, Institut Pasteur, Conservatoire National des Arts et M\u00e9tiers, Paris, \u00cele-de-France, France"},{"name":"MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,11]]},"reference":[{"key":"2025121514353148000_13.12.e072403.1","unstructured":"UNAIDS . 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