Urban-rural disparities in HIV testing uptake and associated factors in Tanzania: A stratified analysis of the 2022 demographic and health survey

Abstract

HIV testing is critical for global HIV control and entry into prevention, treatment, and care. Tanzania has made significant strides in increasing testing services, although disparities in acceptance still exist, especially between urban and rural populations. This study examined urban-rural HIV testing uptake disparities and associated factors using nationally representative data from the 2022 Tanzania Demographic and Health Survey. A cross-sectional analysis was undertaken on 21,017 people aged 15 to 49 years. The primary outcome was self-reported HIV testing history. A stratified analysis was conducted between urban and rural residents. Descriptive statistics were conducted to estimate prevalence, and modified Poisson regression models with robust variance were fitted to obtain adjusted prevalence ratios (aPRs) and 95% confidence intervals. Urban areas (78.5%) had higher HIV testing uptake than rural areas (74.9%). Women and older individuals tested more in both settings, whereas adolescents (15-19 years) tested least. Marital status, mobile phone ownership, internet use, and behavioral risk factors are strongly associated with HIV testing in urban and rural populations. Education, media, and geography were associated more in rural populations. Men tested less than women in both settings (urban aPR = 0.82; rural aPR = 0.78). Geographic differences were greater in rural areas. Although HIV testing uptake in Tanzania is relatively high, urban–rural disparities persist. Rural populations are more affected by structural and informational barriers, while behavioural factors play a greater role in urban settings. These findings highlight the need for context-specific interventions to improve equitable HIV testing coverage in Tanzania.