Geographic variations and determinants of ever-tested for HIV among women aged 15–49 in Sierra Leone: a spatial and multi-level analysis

From 2008 to 2019, the rate of women aged 15-49 years ever tested for HIV showed a significant increase. The expansion of HIV testing hotspots highlights progress in geographic coverage, but disparities remain, particularly in rural areas. Younger women (aged 20-34) and those with higher education, wealth, or access to healthcare services were more likely to be tested, underscoring the influence of socioeconomic and structural factors on testing uptake. The lower odds of testing among older women and Muslims point to the need for targeted interventions addressing cultural barriers. Media exposure, parity, and sexual activity emphasize the role of reproductive health and awareness in promoting testing. Efforts to improve access to healthcare in rural areas and address logistical challenges, such as distance to health facilities, are critical for equitable HIV testing coverage. Strengthening community-based outreach and culturally sensitive programs could further close the gaps in testing uptake. The sustained increase in testing prevalence from 2008 to 2019 reflects progress but also highlights the need for continuous investment in HIV testing programs.