{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:55:08Z","timestamp":1791536108673,"version":"4.3.4"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescent girls and young women (AGYW) in Sub-Saharan Africa (SSA) face a disproportionate HIV risk. Achieving UNAIDS 95-95-95 targets requires high diagnostic coverage, yet critical gaps persist. This multi-country study evaluated individual- and community-level factors associated with HIV testing across 21 SSA nations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Secondary data analysis was performed on a pooled sample of 92,935 young women (ages 15\u201324) from recent Demographic and Health Surveys (DHS) across 1,678 primary sampling units (clusters). Multi-level mixed-effects logistic regression was utilized to assess individual (Level-1) and contextual community-level (Level-2) factors associated with lifetime HIV testing practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lifetime HIV testing prevalence was 44.74% (n = 41,576), exposing a 55.26% testing gap. In the fully adjusted model (Model III), age (20\u201324 vs. 15\u201319 years: Adjusted Odds Ratio (AOR) = 2.342, 95% Confidence Interval (CI: 2.262, 2.424) and higher formal education (AOR) = 4.975, 95% (CI: 4.548, 5.443) were strongly associated with testing. Marital status showed significant associations, peaking among widowed, divorced, or separated women (AOR) = 5.160, 95% (CI: 4.665, 5.706). Comprehensive HIV knowledge doubled the odds of testing (AOR) = 2.024, 95% (CI: 1.958, 2.093). Contextually, high community media saturation was positively associated with testing (AOR) = 2.803, 95% (CI: 2.295, 3.422), whereas high community-level education demonstrated an inverse association (AOR) = 0.314, 95% (CI: 0.261, 0.378). The residual Median Odds Ratio (MOR = 1.30) indicated moderate cluster-level variation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HIV testing practices among SSA young women are associated with nested sociodemographic, cognitive, and community-level factors. Strategies targeting expanded community media engagement, youth-friendly out-of-clinic screening, and discreet HIV self-testing options may help improve diagnostic coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582261494706","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T14:42:43Z","timestamp":1790865763000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Individual and Contextual Determinants of HIV Testing Practices Among Adolescent Girls and Young Women in Sub-Saharan Africa: A Multi-Level Mixed-Effects Analysis"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0840-8707","authenticated-orcid":false,"given":"Tsegaamlak Kumelachew","family":"Derse","sequence":"first","affiliation":[{"name":"Debark University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8087-9845","authenticated-orcid":false,"given":"Desalegn Mitiku","family":"Kide","sequence":"additional","affiliation":[{"name":"Debark University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5438-8237","authenticated-orcid":false,"given":"Addisu Simachew","family":"Asgai","sequence":"additional","affiliation":[{"name":"Debark University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5489-3559","authenticated-orcid":false,"given":"Tadios","family":"lidetu","sequence":"additional","affiliation":[{"name":"Debark University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenberu Mekurianew","family":"Kelkay","sequence":"additional","affiliation":[{"name":"Debark University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemenu","family":"Addis","sequence":"additional","affiliation":[{"name":"Debark University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asaye Worku","family":"Agegn","sequence":"additional","affiliation":[{"name":"Debre Berhan University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"crossref","unstructured":"Mjrojphm M. 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