Spatial mapping of HIV testing and antiretroviral therapy initiation uptake among the adolescents and youth in rural KwaZulu-Natal, South Africa

This study investigated the spatial distribution of HIV testing and antiretroviral therapy initiation among adolescents and youth in rural KwaZulu-Natal, South Africa, to inform the optimal allocation of HIV services. The sample included 5,352 participants aged 13-35 years from nested cohort studies within Africa's largest population-based prospective cohorts, with global positioning system data collected for all homesteads. HIV testing prevalence and ART initiation prevalence were mapped using a kernel density approach, and socio-demographic correlates were examined using multivariable regression. Kernel density mapping revealed substantial geographic disparities in HIV testing and ART initiation. Multivariable analysis showed that tertiary education (aβ: 4.53; 95% CI: 2.11, 6.88), rural residence (aβ: -31.14; 95% CI: -32.32, -29.65), and living within 3 km of a health facility (aβ: -2.42; 95% CI: -3.88, -0.96) were associated with HIV testing prevalence. ART initiation prevalence was associated with rural residence (aβ: -5.44; 95% CI: -7.38, -3.37), participation in HIV self-testing (aβ: 3.21; 95% CI: 0.64, 5.80), and lack of participation in STI screening and treatment (aβ: -1.22; 95% CI: -2.44, -0.03). Our research underscores the urgent need for addressing geographical access to HIV testing and treatment uptake amongst adolescents and youth in rural communities, and promoting HIV self-testing.