Bayesian hierarchical analysis of gender and socioeconomic inequalities in HIV testing uptake in Ghana

Despite global efforts to reduce HIV/AIDS, sub‑Saharan Africa continues to bear the highest proportion of new infections and HIV‑related morbidity, making HIV testing a critical component of prevention and treatment. Traditional regression analyses have identified gender and socioeconomic inequalities in testing; however, they may be limited by sparse subgroups within hierarchical survey data. This study examines how these inequalities vary across communities in Ghana, providing evidence to guide interventions and policies that promote equitable HIV testing coverage. Data were obtained from the Ghana Demographic and Health Survey, including 22,058 participants. A Bayesian multilevel logistic regression model was used to examine factors associated with HIV testing uptake. Socioeconomic inequalities were assessed using the Erreygers Concentration Index, which was further decomposed to identify key contributors to inequality across wealth groups. Bayesian estimates reported an adjusted Odds Ratio (aOR) and a 95% credible interval, while bivariate analysis used a 5% significance level. Overall, less than 50% of the participants had ever tested for HIV, with testing among men 26.9%(95%CI:25.3,28.6) and women 57.4% (95%CI: 55.9,58.7). The likelihood of HIV testing uptake among men was significantly 83% less (aOR = 0.17; 95% CrI: 0.14, 0.19) compared with women. The findings revealed that men aged 25—29 years had higher odds of HIV testing compared with those aged 15—19 years (aOR = 22.74; 95% CrI: 5.30, 54.32). Similarly, women in the same age group also had higher odds of HIV testing (aOR = 11.01; 95% CrI: 6.82, 18.60). HIV testing uptake showed pro-rich inequality in the study population, with higher inequality among men compared to women. Men contribution reduced overall socioeconomic inequality by 39.7% in HIV testing uptake. HIV testing uptake among Ghanaians remain low, particularly among men. Gender, age, education, residence, and socioeconomic status were factors associated with testing uptake. Moreover, HIV testing was disproportionately concentrated among wealthier populations. These findings suggest the need for equity-focused HIV testing strategies that address both individual and structural barriers, targeting men, rural populations, and socioeconomically disadvantaged groups.