Original Research Determinants of Pathways to Hiv Testing in Rural and Urban Kenya: Evidence from the 2008 Kenya Demographic and Health Survey

Objectives: Existing evidence in sub-Saharan Africa indicates that less than 40% of people living with HIV are aware of their status. HIV testing and counselling (HTC) is one of the key national strategies for HIV prevention but rural-urban inequalities exist in the uptake of this service. The aim of this study was to determine the factors associated with the uptake of HIV testing and counselling through the providerinitiated testing and counselling (PITC) and client-initiated testing and counselling (CITC) pathways in rural and urban areas in Kenya. Methods: Retrospective cross-sectional data were derived from the 2008-2009 Kenya Demographic and Health Survey. Descriptive statistics and multinomial logistic regression analysis were used to describe the characteristics of the sample and to identify the determinants of pathways to HIV testing. Results: Overall, in the rural areas, 66.3% of respondents had never tested for HIV, 17.3% had been tested through CITC and 16.3% through PITC. In urban areas, 49.6% of respondents had never tested, 30.4% had been tested through CITC and 19.9% through PITC. In both rural and urban areas, men were significantly more likely to test for HIV through CITC, while women were significantly associated with PITC. Individuals aged 15 to 19 years, households in the poorest quintile, and rural and urban areas in the North Eastern Province were less likely to utilize CITC and PITC services. Conclusion: The findings highlight the need to increase testing coverage in rural areas where a greater proportion of people had never been tested. There is also need to address existing disparities in HIV testing across different groups and geographic provinces. Targeted efforts aimed at reaching individuals aged 15 to 19 years, the poorest households, and people residing in the North Eastern Province are critical for increasing HIV testing uptake.