Spatial distribution and factors associated with recent HIV testing prevalence among adolescents and young women (AYW) in Sierra Leone: evidence from the Sierra Leone demographic and health survey 2019

Adolescent and young women (AYW) in Sierra Leone face high HIV risk and low testing rates, hindering progress toward the 95-95-95 targets. This study examines the spatial distribution and factors influencing recent HIV testing among AYW in Sierra Leone using the 2019 Sierra Leone Demographic and Health Survey, which included 6,062 participants aged 15-24. Techniques such as spatial autocorrelation (Moran's I), hotspot analysis (Getis-Ord GI*), and Kriging interpolation identified testing clusters, alongside a multilevel logistic regression model for associated factors. Hotspots for testing were found in Kailahun and Kenema, while cold spots were noted in Karene, Falaba, and Tonkolili. Approximately 24.3% of AYW reported recent testing. Key factors linked to recent testing included being aged 20-24, having multiple sex partner, age at first sex (before age 18), age at first sex (18 and above), history of sexually transmitted infections (STIs), and HIV knowledge. Regional disparities were evident, with lower testing odds in the Northern, Northwestern, and Southern regions compared to the Eastern region. The study recommends a multilevel approach, integrating targeted outreach in high-risk areas with community education and awareness campaigns to address disparities in HIV testing among AYW in Sierra Leone.