{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:57:57Z","timestamp":1781002677423,"version":"3.54.1"},"reference-count":59,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,20]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study assessed the spatial distribution of HIV test non-uptake among pregnant women who attended antenatal care (ANC) in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sub-Saharan Africa (SSA) region. 24 SSA countries were included in this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data source<\/jats:title>\n                    <jats:p>Demographic and Health Survey (DHS), 2016\u20132024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>82\u2009397\u2009women who were pregnant in the last 2 years preceding the survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measure<\/jats:title>\n                    <jats:p>HIV test non-uptake, which is a legacy indicator of HIV test among pregnant women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>The HIV test non-uptake among ANC attending pregnant women was 39.6% (95% CI 39.27% to 39.93%). The spatial autocorrelation test revealed that HIV testing non-uptake among pregnant women was clustered. The global Moran\u2019s I value was 0.48 with a p value &lt;0.01. Hotspot areas were those with high rates of HIV testing non-uptake. These hotspot areas were located in most parts of Mali, Mauritania, Madagascar, Guinea, Senegal, central parts of Angola, eastern part of Senegal and northern parts of Ethiopia. The Multiscale Geographical Weighted Regression (MGWR) model explained 91% of the spatial variation of HIV test non-uptake among pregnant women, who were in the age group 15\u201319 years, had no formal education and no health insurance, and less than four antenatal care contacts were significantly associated with HIV test non-uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There was a significant geographical variation in HIV test non-uptake among pregnant women attending antenatal care (ANC) in sub-Saharan Africa. Prioritising hotspot areas with high rates of HIV test non-uptake for spatially targeted interventions is essential. Policymakers, health professionals, and other stakeholders should focus on improving women\u2019s formal education, expanding health insurance coverage, and increasing ANC contacts to ensure that each visit includes HIV screening. Moreover, special attention should be given to younger women to enhance HIV testing uptake among those attending ANC in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102883","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:06:51Z","timestamp":1780999611000},"page":"e102883","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Spatial variation in HIV test non-uptake among antenatal care\u2013attending pregnant women in sub-Saharan Africa: a cross-sectional study using demographic and health survey data"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4595-3919","authenticated-orcid":false,"given":"Eyob Akalewold","family":"Alemu","sequence":"first","affiliation":[{"name":"Department of Public Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia"},{"name":"Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2692-7394","authenticated-orcid":false,"given":"Simachew Getaneh","family":"Endalamew","sequence":"additional","affiliation":[{"name":"Department of Veterinary Epidemiology and Public Health, School of Veterinary Medicine, Bahir Dar University, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2807-1019","authenticated-orcid":false,"given":"Helen Brhan","family":"Alemaw","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0417-5716","authenticated-orcid":false,"given":"Halima Ayalew","family":"Kebede","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6988-9471","authenticated-orcid":false,"given":"Solomon Keflie","family":"Assefa","sequence":"additional","affiliation":[{"name":"Department of Public Health, Pawi Health Science College, Pawi, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7285-2971","authenticated-orcid":false,"given":"Endalew Minwuy","family":"Andarge","sequence":"additional","affiliation":[{"name":"Department of Public Health, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Birhan, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliyas Addisu","family":"Taye","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5777-1269","authenticated-orcid":false,"given":"Dejen Kahsay","family":"Asgedom","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Science, Samara University, Samara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8620-5565","authenticated-orcid":false,"given":"Sofiya Ayalew","family":"Kebede","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adem Tsegaw","family":"Zegeye","sequence":"additional","affiliation":[{"name":"Department of Health Informatics, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belayneh Jejaw","family":"Abate","sequence":"additional","affiliation":[{"name":"University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"2026060804451618000_16.6.e102883.1","unstructured":"World Health Organization . 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