HIV testing uptake and the effect of health education on HIV self-testing among undergraduate students in public universities in Imo State, Nigeria

Africa bears the highest global burden of HIV/AIDS, with young people disproportionately affected. University students are at increased risk of HIV infection due to campus-related lifestyle factors. HIV self-testing (HIV-ST) represents a promising strategy to enhance HIV diagnosis rates and support progress toward the UNAIDS 95-95-95 targets. This study evaluated the proportion of undergraduate students in Imo State, Nigeria, who underwent HIV counseling and testing (HCT) in the past year. A secondary objective was to assess the effect of health education on HIV-ST uptake among participants. The study employed a cross-sectional design with embedded intervention and included all government-owned universities and polytechnics in Imo State: Federal University of Technology Owerri (FUTO), Imo State University (IMSU), Federal Polytechnic Nekede (FEP), and University of Agriculture and Environmental Sciences (UAES). Simple random sampling and systematic random sampling were used to select the participants. A total of 317, 316, 421 and 359 were sampled from FEP, IMSU, FUTO and UAES respectively. A health education intervention was administered to increase HIV testing uptake; particularly HIV-ST. Data were collected from participants aged 16-25 years between October and December 2025 using an adapted structured questionnaire. Statistical analysis, using the chi-square test, was used to examine associations between participants' socio-demographic characteristics and HIV testing uptake. Results indicated that HIV testing uptake among participants in the past year was 178 (42.3%) at FUTO, 174 (48.5%) at UAES, 77 (24.4%) at IMSU, and 95 (30%) at FEP. Prior to the health education intervention, none of the students had previously used HIV-ST. Following the health education intervention, HIV-ST uptake increased to 53 (29.8%), 48 (27.6%), 30 (38.9%), and 34 (35.8%) at FUTO, UAES, IMSU, and FEP, respectively. The overall HIV testing uptake and HIV-ST of the participants was 37.1%, and 11.7% respectively. Statistical analysis revealed that marital status and gender influenced HIV testing uptake, with married participants and females more likely to be tested. HIV testing uptake among undergraduates in Imo State remains low, with all institutions reporting rates below 50%, which is significantly lower than the UNAIDS 95% target. This raises concerns about Nigeria's ability to achieve the UNAIDS 2030 target. Health education was shown to be an effective strategy for increasing HIV-ST among the participants. It is recommended that health education be integrated into national strategies to enhance HIV testing uptake, with particular attention to young adults, especially males, in the design and implementation of voluntary counseling and testing services.