Sociodemographic inequalities in the uptake of prenatal HIV testing in Ethiopia: Systematic review and meta-analysis

Background: HIV testing is crucial for preventing, treating, and managing HIV. Equal access to testing services for all social groups is important to combat the spread of HIV. Measuring socioeconomic inequalities in healthcare usage is essential for promoting health equity and achieving universal health coverage and the United Nations' Sustainable Development Goals. Up to our level of knowledge, there is no previous systematic review or meta-analysis on sociodemographic inequalities in prenatal HIV testing in Ethiopia. Therefore, this study aimed to provide a comprehensive analysis of prenatal HIV testing prevalence and investigate the impact of sociodemographic factors on its uptake. Methods: We conducted a thorough search across multiple databases, including PubMed, Scopus, Google Scholar, and Embase, to gather articles and reports. The extracted data was then exported to R software for meta-analysis. We performed a meta-analysis of proportions using a Random effect model. Additionally, we analyzed the impact of sociodemographic characteristics. Heterogeneity among the included studies was assessed using I2 statistics and the Cochran's Q test. The pooled prenatal HIV testing, along with its corresponding 95% CI, was presented using a forest plot. Results: A comprehensive analysis of 20 research papers on prenatal HIV testing in Ethiopia revealed that the overall prevalence of testing was 69% (95% CI [60.0-80.0]). Factors such as higher education, urban residence, awareness of HIV/AIDS, positive attitude towards testing, marriage, and discussions about testing during ANC were found to positively influence testing rates. Conclusion: To improve prenatal HIV testing rates, targeted programs should focus on specific groups of women, such as those in rural areas with limited education, unmarried status, negative attitudes towards testing, and poor socioeconomic conditions. Sociodemographic inequalities in HIV testing, particularly affecting women in the low income, highlight the need for targeted initiatives in Ethiopia's public health programs. To improve women's access to HIV testing, efforts should focus on reducing female illiteracy, enhancing maternal health services, addressing poverty, and providing comprehensive HIV education to empower women and minimize missed opportunities for testing. By implementing these strategies, we can improve testing rates and work towards achieving the UNAIDS target by 2030. As limitation this systematic review not included longitudinal and qualitative study that might be provide different results.