Sociodemographic, psychosocial, and contextual factors associated with HIV testing uptake among adults across five districts in Ghana: a cross-sectional study

HIV testing uptake remains a critical gap in Ghana’s progress toward epidemic control, with only 68% of people living with HIV knowing their status. This study exploratorily examined sociodemographic, psychosocial, and contextual factors associated with HIV testing uptake among general community adults across five purposively selected districts in Ghana. A descriptive cross-sectional study was conducted among 1,181 adults aged ≥ 18 years across five purposively selected districts spanning five administrative regions of Ghana. Data were collected using a structured questionnaire. Bivariate and multivariable logistic regression identified factors associated with HIV testing uptake, with results reported as crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). As a post-hoc exploratory step, interactions between study district and each of the four composite psychosocial measures HIV knowledge, attitudes towards people living with HIV, Anticipated and disclosure-related stigma, and perception of equity and rights were assessed using interaction terms and joint Wald tests. Statistical significance was set at p < 0.05. HIV testing uptake was 54.7%. Good HIV knowledge was observed in 53.6% of participants, favourable attitudes towards people living with HIV in 51.0%, high anticipated and disclosure-related stigma in 53.3%, and high equity and rights perception in 68.1%. In multivariable analysis, older age (25–34 years: aOR = 1.63, 95% CI: 1.13–2.36; ≥45 years: aOR = 2.01, 95% CI: 1.26–3.21), formal employment (aOR = 1.73, 95% CI: 1.11–2.70), urban residence (aOR = 1.61, 95% CI: 1.19–2.16), Waala/Dagao/Sissala ethnicity (aOR = 1.98, 95% CI: 1.08–3.62), any reported income above zero, and high equity and rights perception (aOR = 1.57, 95% CI: 1.16–2.11) were associated with higher odds of testing. Junior high school and pre-tertiary education were associated with lower odds compared with no formal education. Testing odds were higher in Saboba, West Akim, and West Gonja than in Ablekuma South. The association between attitudes towards people living with HIV and HIV testing uptake varied across districts (Wald χ²(4) = 20.79, p < 0.001); favourable attitudes towards people living with HIV were associated with higher testing odds in Ablekuma South (aOR = 1.83, 95% CI: 1.00–3.34) and Wa Metropolitan (aOR = 2.90, 95% CI: 1.60–5.25), but with lower odds in Saboba District (aOR = 0.46, 95% CI: 0.25–0.86). HIV testing uptake was associated with predisposing, enabling, psychosocial, and contextual factors, consistent with Andersen’s Behavioural Model. The attitude–testing association varied by district, underscoring the need for locally tailored HIV testing strategies. Longitudinal and intervention research is needed to establish causal pathways and evaluate district-specific approaches.