Urban-Rural Disparities in Pediatric HIV Testing Uptake in Ethiopia: A Cross-Sectional Analysis of the 2016 Ethiopian Demographic and Health Survey.

IntroductionHIV testing is vital for early detection and treatment linkage, yet uptake among children remains a global challenge. The 2016 Ethiopian Demographic and Health Survey (EDHS) revealed low HIV testing prevalence in children under 15 years old, with significant urban-rural disparities. This study analyzes these disparities and their contributing factors using EDHS data.MethodsA cross-sectional analysis of the 2016 EDHS was conducted using STATA version 17.0. Chi -square tests were used to assess the associations between HIV testing uptake and independent variables, while multivariate decomposition analysis was used to analyze the factors associated with the urban-rural disparities of pediatric HIV testing uptake. Statistical significance was declared, at p-values < 0.05, with 95% confidence intervals reported. The results were presented using text, tables, and figures.ResultsThe overall prevalence of pediatric HIV testing uptake was 18.61% (95% CI: 18.15%-19.07%), with significantly higher uptake in urban areas (35.66%) compared to rural areas (14.91%) (p < 0.001). A multivariate decomposition analysis revealed a substantial urban-rural disparity (0.21, p < 0.001), of which 50.34% was explained by differences in population characteristics, while 49.66% was due to differences in the effects of these characteristics. Key contributors to the disparity included household wealth, maternal education, child age, family size, premarital HIV testing, and consent refusal.Conclusion and RecommendationThis study revealed a significant urban-rural disparity in pediatric HIV testing uptake, largely explained by differences in population characteristics. Thus, family size and parental education, were found to contribute to increased disparities. Conversely, premarital HIV testing, refusal of consent, and older maternal age demonstrated effects that influenced and, in some cases, reduced the observed gap. The findings suggest the need for targeted, equity-focused interventions to reduce urban-rural disparities in pediatric HIV testing.