Undiagnosed HIV infection and factors associated with recent HIV testing among key populations at higher risk for HIV in Mozambique

Background: HIV testing saves lives. It is fundamental to combating the global HIV epidemic. Key populations at higher risk for HIV in Mozambique, including Men who have Sex with Men (MSM), Female Sex Workers (FSW) and mineworkers, are in urgent need of effective HIV prevention strategies. This is the first analysis ever conducted in Mozambique to identify levels of HIV testing and associated factors that inform these strategies. Methods: This analysis used data from seven cross-sectional surveys conducted between 2011-2012 among MSM, FSW and Mineworkers in Mozambique. Participants completed a questionnaire and provided blood samples for HIV testing. MSM and FSW were recruited used Respondent Driven Sampling in Maputo, Beira and Nampula. Mineworkers were recruited using Time Location Sampling in Ressano-Garcia. Participants with previous HIV-positive tests or missing HIV test histories were excluded (<5% overall). Weighted logistic regression was used to measure associations with recent HIV testing (<12 months). Theory-driven multivariate logistic regression was conducted in R v2.15 using the Health Behavior Model as a conceptual framework. Results: The prevalence of recent testing for HIV ranged from 29.8-59.5%, yet 4.4-25.0% had HIV and did not know it. Between 11.9-57.4% had never been tested, and fear was given as the primary barrier. Recent HIV testing was positively associated with knowledge of ARV drugs, knowing the HIV status of a sexual partner, knowing where to go to get tested, and having had contact with a peer educator. It was negatively associated with having had a genital sore or ulcer and unprotected sex. Between 32.1-90.0% of HIV-positive undiagnosed, key population members had used a healthcare service in the previous 12 months and 23.4-47.5% had tested negative for HIV in that time period. Conclusion: Routine testing with strengthened post-test counseling encouraging key populations to have annual HIV screenings need to be implemented in Mozambique