Routine referral or offer of HIV counselling and testing among health facilities providing sexually transmitted infection services in Ethiopia: a facility-based analysis

Routine referral or offer of HIV counselling and testing among clients receiving sexually transmitted infection (STI) services is an important component of STI–HIV service integration. However, national facility-level evidence on routine referral or offer of HIV counselling and testing among STI clients in Ethiopia is limited. This study assessed the prevalence of facility-reported routine referral or offer of HIV counselling and testing among STI clients and examined associated facility characteristics. A secondary analysis was conducted using the 2021–2022 Ethiopia Service Provision Assessment (SPA), a national health facility survey. The analysis included 1,407 facilities providing STI services; 881 facilities with complete information were included in the multivariable analysis. Facility characteristics included location, facility type, managing authority, STI record availability, consultation privacy, STI counselling practices, and number of STI service providers. Survey-weighted logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). The outcome represents facility-reported routine referral or offer of HIV counselling and testing among STI clients; the SPA measure does not distinguish on-site or intra-facility provision from referral to another facility and does not measure completion of HIV testing or subsequent linkage to care. Overall, 56% of facilities reported routine referral or offer of HIV counselling and testing among STI clients. Rural facilities had lower odds of routine referral or offer of HIV counselling and testing than urban facilities (AOR = 0.37, 95% CI 0.18–0.76). Compared with referral hospitals, the odds of routine referral or offer of HIV counselling and testing were lower among higher clinics (AOR = 0.01, 95% CI 0.00–0.12), medium clinics (AOR = 0.10, 95% CI 0.02–0.54), and lower clinics (AOR = 0.04, 95% CI 0.01–0.28). Consultation privacy showed heterogeneous associations with referral practices. Managing authority, STI record availability, counselling topics, and the number of STI service providers were not statistically associated with routine referral. Routine referral or offer of HIV counselling and testing varied by facility location and type, with lower reported routine referral or offer in rural facilities and several clinic categories than in referral hospitals. Strengthening STI–HIV service integration, including functional testing and referral mechanisms in rural and lower-level facilities, may help address facility-level gaps in HIV testing provision.