Prevalence and Determinants of HIV Testing Practice Among Young Women in Nigeria: A Multilevel Analysis of the 2024 Demographic and Health Survey

Background Human immunodeficiency virus (HIV) disproportionately affects young Nigerian women, yet testing uptake remains suboptimal. This study identified individual- and community-level determinants of HIV testing among this demographic to guide targeted healthcare interventions. Methods A secondary analysis of the 2024 Nigeria Demographic and Health Survey (NDHS) was conducted ( N = 14,634, ages 15-24). Multilevel logistic regression models were applied to account for the hierarchical data structure, with Model III (the full model containing both individual and community-level covariates) demonstrating the best fit based on Akaike information criterion and Bayesian information criterion. Results The prevalence of HIV testing among young women in Nigeria was 21.3%. The multilevel logistic regression analysis revealed that key individual-level factors significantly associated with higher odds of HIV testing included advanced age category, higher educational status, higher wealth index, high individual media exposure, comprehensive HIV knowledge, and a history of sexually transmitted infections. Additionally, marital status was a strong predictor, with married and formerly married women exhibiting significantly higher odds of testing compared to their never-married peers. At the community level, living in communities with high community-level HIV knowledge and high community wealth significantly boosted testing practice. The intraclass correlation coefficient in the null model indicated that 19.0% of the total variance in HIV testing practice was attributable to community-level factors, confirming a notable neighborhood effect. Conclusion HIV testing practices among young Nigerian women are multidimensionally shaped by a prominent “neighborhood effect” alongside individual socioeconomic and marital status. To bridge the current implementation gap in Nigeria, clinical and public health interventions must transition toward decentralized, community-based testing models that intentionally reach out to younger, never-married, and socioeconomically disadvantaged women.