Socioeconomic Inequalities and Spatial Clustering in HIV Testing Uptake in Ghana: A Concentration Index and Geospatial Analysis of the 2022 GDHS

Abstract

ABSTRACT Background Though progress has been made towards universal access to diagnosis and treatment, inequalities in HIV testing are a major obstacle to HIV care in the world, as not everyone has enough access to HIV testing services. Progress is being made towards universal HIV testing and treatment, but inequalities in HIV testing are also an important hurdle to HIV care. Design Cross-sectional secondary analysis Setting Nationally representative survey across all 16 administrative regions of Ghana. Participants 22,058 respondents (15,014 women aged 15-49 and 7,044 men aged 15-59) from the 2022 Ghana Demographic and Health Survey. Primary outcome measure HIV testing uptake, defined as ever having been tested for HIV and received results (binary: yes/no). Aim The aim of this study was to examine socioeconomic inequalities and spatial clustering in uptake of HIV testing in Ghana in the 2022 Ghana Demographic and Health Survey (GDHS). Specifically, it considered the level of inequality in wealth, the factors related to these inequalities, and the spatial distribution of HIV testing and factors associated with uptake of HIV testing. Methods The secondary analysis of cross sectional data was done on 22,058 respondents from all 16 administrative regions of Ghana by using descriptive statistics, Erreygers concentration index, Wagstaff decomposition, spatial autocorrelation techniques, and multilevel logistic regression. Results The findings showed that there was significant pro-rich inequality in HIV testing, with the majority of inequalities observable not being accounted for by the difference in wealth, but in education level. There was a significant geographic clustering with hotspots in the south, and coldspots in the north. HIV testing uptake was significantly predicted by wealth, education, and the age, sex, marital status and being covered by health insurance Conclusion The study revealed that socioeconomic and geographical inequalities still exist and have significant impacts on uptake of HIV testing in Ghana. It suggests specific programs such as those aimed at disadvantaged communities, geographic areas, greater access to health insurance, and improved community-based HIV testing services to help ensure equitable access. Strengths and Limitations This study used nationally representative data from the 2022 Ghana DHS, covering all 16 administrative regions, enhancing the generalisability of findings to the Ghanaian population. The combined application of the Erreygers-corrected Concentration Index, Wagstaff decomposition, spatial autocorrelation, and multilevel logistic regression constitute a methodologically rigorous multi-analytical framework rarely applied together in the Ghanaian HIV testing literature. GPS cluster coordinates in DHS data are randomly displaced by up to 5 km in rural areas, which may introduce imprecision in spatial analysis. The cross-sectional design precludes causal inference; directionality of associations between socioeconomic factors and HIV testing cannot be established. Self-reported HIV testing may be subject to recall or social desirability bias, potentially leading to overestimation of testing uptake.