Spatial mapping and predictors of HIV self-testing use among adolescent girls and young women in Tanzania: evidence from the 2022 Tanzania demographic and health survey

The introduction of HIV self-testing (HIVST) kits has reshaped HIV prevention, ensuring confidentiality and accessibility particularly among underserved populations. Adolescent girls and young women (AGYW) aged 15–24 years often face barriers to HIV testing services such as stigma, discrimination, and limited access to youth-friendly services. HIVST serves as a cornerstone to overcome these barriers. This study assessed spatial variation and predictors of HIV self-testing use among AGYW in Tanzania. This study utilized secondary data from the 2022 Tanzania Demographic and Health Survey, employing analytical cross-sectional survey. This study included 5,852 AGYW selected through two-stage sampling strategy. Spatial autocorrelation and Moran’s I were used to analyze the distribution of this outcome, while mixed-effect multi-level binary logistic regression assessed the factors associated with HIVST uptake. The findings were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). The prevalence of HIVST use among AGYW was 2.3% [95%CI: 1.8,2.9]. Multilevel regression revealed that age, education level, working status, number of sexual partners, age at first sex, ever testing for HIV, wealth index and geographical residence was significantly associated with HIVST use. Spatial analysis reveals that the spatial distribution of HIVST kit use demonstrated clustering in Tanzania, with a global Moran’s I value of 0.058427. This study underscores that HIVST kit use among AGYW in Tanzania is characterized by a significant clustered spatial distribution, with overall low prevalence but distinct geographical hotspots and cold spots. Key determinants such as older age, higher education, employment, certain sexual behaviors, prior HIV testing, and higher socioeconomic status are positively associated with HIVST uptake. The identified spatial disparities and associated factors necessitate a nuanced and geographically targeted approach to HIV prevention strategies.