Spatial Variations and Factors Influencing HIV Testing Access in Guinea: A Secondary Analysis of the 2018 Demographic and Health Survey Data

<i>Background</i>: HIV is a chronic infection that weakens the immune system. In sub-Saharan Africa, and more specifically in Guinea, access to HIV testing remains a significant issue in certain areas, with geographic disparities. This study aimed to analyze spatial variations and factors influencing access to HIV testing among men and women aged 15 to 49 years in Guinea in 2018. <i>Methods</i>: This was a secondary analysis of existing data. This study utilized data from the 2018 Demographic and Health Survey (DHS) in Guinea. It was an ecological, cross-sectional study where the statistical unit was the health area. Spatial analysis was conducted through Moran's I coefficient, local autocorrelation, hot and cold spot analysis, and ordinal logistic regression. <i>Results</i>: Data from a total of 14,451 individuals distributed across 340 health areas and 38 health districts were analyzed. Most individuals had at least partial access to testing across all health areas. The percentages of moderate and optimal access decreased progressively among those with partial access. A significant global spatial autocorrelation was observed (I = 0.170; p < 0.001) for moderate access percentages and optimal access percentages (I = 0.232; p < 0.001). Age (OR = 1.005; 95% CI: 1.001-1.009; p = 0.009), gender (OR = 0.517; 95% CI: 0.481-0.555; p < 0.001), socioeconomic status (OR = 1.119; 95% CI: 1.031-1.215; p < 0.001), and residential setting (OR = 1.384; 95% CI: 1.239-1.491; p < 0.001) were significantly associated with testing access. <i>Conclusion</i>: This study reveals substantial geographic disparities in HIV testing access in Guinea, influenced by age, gender, socioeconomic status, and residence. Despite widespread awareness, moderate and optimal access remains limited, especially in rural areas. Targeted public health strategies such as community-based interventions, service decentralization, and integration into primary care are essential to improving coverage and ensuring equitable HIV service access nationwide.