DETERMINANTS OF HIV STATUS UNAWARENESS AND ANTIRETROVIRAL THERAPY USE AMONG PEOPLE WITH HIV IN ESWATINI
Author(s)
Osaro Mgbere, PhD, MS, MPH1, Victoria Owoyele, DrPH, MPH2, Javeria Khalid, MPhil, PhD3, Tarilate Temedie-Asogwa, PharmD, MSc3, Jieni Li, PhD, MPH3, Omolola Adepoju, PhD, MPH1, Winston Liaw, MD, MPH1, Ekere J. Essien, MD, DrPH3;
1University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA, 2Capella University, Minneapolis, MN, USA, 3University of Houston, College of Pharmacy, Houston, TX, USA
1University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA, 2Capella University, Minneapolis, MN, USA, 3University of Houston, College of Pharmacy, Houston, TX, USA
OBJECTIVES: Despite widespread HIV testing and ART availability, gaps in status awareness and treatment uptake persist in Eswatini. This study assessed sociodemographic, behavioral, clinical, and geographic factors associated with HIV status unawareness and ART use among people with HIV to inform targeted interventions.
METHODS: We analyzed cross-sectional data from 5,803 HIV-positive individuals in a nationally representative population-based survey. HIV status awareness and ART use were classified into three mutually exclusive categories: unaware of HIV-positive status, aware but not on ART, and aware and on ART. Weighted chi-square tests assessed bivariate associations. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for comparisons of (1) unaware vs. aware not on ART, (2) unaware vs. aware on ART, and (3) aware not on ART vs. aware on ART. Predictor importance was assessed using LogWorth statistics.
RESULTS: Overall, 37.6% of participants were unaware of their HIV-positive status, 30.4% were aware but not on ART, and 32.0% were aware and on ART. Gender, age, marital status, education, sexual behavior, viral load, and region were significantly associated with awareness and ART use (all p<0.01). Women had higher odds of being unaware (aOR=3.04, 95% CI: 2.93-3.15) and aware but not on ART (aOR=1.62, 95% CI: 1.55-1.71), and lower odds of being aware and on ART (aOR=0.60, 95% CI: 0.56-0.63). Viral load was the strongest predictor of ART use across models. Higher education was consistently protective against unawareness and ART non-use. Regional disparities persisted, with higher unawareness in Lubombo and lower ART use in Manzini and Shiselweni.
CONCLUSIONS: Significant gaps in HIV status awareness and ART use persist in Eswatini due to intersecting sociodemographic, behavioral, clinical, and geographic factors. Targeted, region-specific strategies prioritizing testing, linkage, and retention, especially for women, younger adults, and less-educated populations, are essential to achieving UNAIDS targets and improving population-level HIV outcomes.
METHODS: We analyzed cross-sectional data from 5,803 HIV-positive individuals in a nationally representative population-based survey. HIV status awareness and ART use were classified into three mutually exclusive categories: unaware of HIV-positive status, aware but not on ART, and aware and on ART. Weighted chi-square tests assessed bivariate associations. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for comparisons of (1) unaware vs. aware not on ART, (2) unaware vs. aware on ART, and (3) aware not on ART vs. aware on ART. Predictor importance was assessed using LogWorth statistics.
RESULTS: Overall, 37.6% of participants were unaware of their HIV-positive status, 30.4% were aware but not on ART, and 32.0% were aware and on ART. Gender, age, marital status, education, sexual behavior, viral load, and region were significantly associated with awareness and ART use (all p<0.01). Women had higher odds of being unaware (aOR=3.04, 95% CI: 2.93-3.15) and aware but not on ART (aOR=1.62, 95% CI: 1.55-1.71), and lower odds of being aware and on ART (aOR=0.60, 95% CI: 0.56-0.63). Viral load was the strongest predictor of ART use across models. Higher education was consistently protective against unawareness and ART non-use. Regional disparities persisted, with higher unawareness in Lubombo and lower ART use in Manzini and Shiselweni.
CONCLUSIONS: Significant gaps in HIV status awareness and ART use persist in Eswatini due to intersecting sociodemographic, behavioral, clinical, and geographic factors. Targeted, region-specific strategies prioritizing testing, linkage, and retention, especially for women, younger adults, and less-educated populations, are essential to achieving UNAIDS targets and improving population-level HIV outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH12
Topic
Epidemiology & Public Health
Disease
SDC: Infectious Disease (non-vaccine), SDC: Reproductive & Sexual Health, STA: Alternative Medicine, STA: Personalized & Precision Medicine