Prevalence and Factors Associated with Family-Based HIV Index Case Testing in Wolaita Zone, Southern Ethiopia, 2023: A Cross-Sectional Study

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Data are limited in southern Ethiopia. Methods: A facility-based cross-sectional study was conducted among 377 adults on antiretroviral therapy (ART) in Wolaita Zone, Southern Ethiopia, from November 2022 to May 2023. Participants were selected using systematic random sampling. Data were collected via interviewer-administered semi-structured questionnaire. Multivariable logistic regression identified factors associated with index case family testing. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated, and statistical significance was declared at p < 0.05. Results: The proportion of index case family testing for HIV was 84.9% (95% CI: 81.2–88.6). In multivariable analysis, urban residence (AOR = 2.8; 95% CI: 1.16–6.75), duration on ART greater than 12 months (AOR = 13.0; 95% CI: 4.6–36.9), disclosure of HIV status to family members (AOR = 5.6; 95% CI: 1.9–16.5), discussion of HIV status with family members (AOR = 6.6; 95% CI: 1.9–23.2), and being counselled by health professionals to bring families for testing (AOR = 6.3; 95% CI: 2.1–19.0) were significantly associated with index case family testing. Conclusion: The prevalence of family-based HIV index case testing in Wolaita Zone was 84.9% (95% CI: 81.2–88.6), which is below the national 95% target. Health professionals should strengthen counselling on ART adherence, status disclosure, family discussion, and active referral, as these factors were significantly associated with higher testing uptake among family members of people living with HIV. HIV/AIDS index case testing family-based testing Ethiopia Figures Figure 1 INTRODUCTION The human immunodeficiency virus (HIV) continues to be a major global public health concern. In 2021, an estimated 38.4 million people were living with HIV worldwide, with approximately 650,000 AIDS-related deaths and 4,000 new infections daily [1]. The Joint United Nations Programme on HIV/AIDS (UNAIDS) established the 95-95-95 targets aiming to diagnose 95% of all HIV-positive individuals, provide antiretroviral therapy (ART) to 95% of those diagnosed, and achieve viral suppression in 95% of those treated by 2030 [2]. However, an estimated 40% of people living with HIV (PLHIV) remain undiagnosed globally [3]. HIV testing and counselling is a critical gateway to ART access, which reduces morbidity, mortality, and HIV transmission through viral suppression [4]. While traditional facility-based testing approaches such as voluntary counselling and testing (VCT) and provider-initiated testing and counselling (PITC) have been widely implemented, alternative strategies are needed to reach undiagnosed populations. Index case testing—where a person with confirmed HIV infection is asked to contact family members, including children, spouses, sexual partners, siblings, and parents for HIV testing—has demonstrated higher positivity rates compared to other testing methods [5,6]. The World Health Organization recommends targeted HIV testing strategies such as index-linked testing to improve efficiency and reduce costs [7]. Index testing has proven effective in several sub-Saharan African countries, including Ethiopia, for identifying and enrolling previously undiagnosed individuals into ART [8,9]. The Ethiopian government has implemented index testing as part of its national HIV strategic plan [10]. Despite these efforts, evidence from sub-Saharan Africa, including Ethiopia, indicates that only 32–55% of adolescents are ever tested for HIV, and delayed diagnosis increases both further HIV transmission and mortality risk [11,12]. Barriers to testing include stigma, discrimination, and lack of confidential testing environments [13]. A recent population-based survey in Ethiopia found that only 40% of women had been previously tested, suggesting a substantial proportion of HIV-seropositive individuals remain unaware of their status [14]. Previous studies have identified age, residence, education, wealth, condom use, healthcare access, HIV knowledge, and substance use as factors affecting HIV testing. However, these factors vary across populations, countries, and regions [15,16]. Up to 70% of partners and family members of PLHIV are also HIV-positive, yet many remain untested [17]. Without targeted identification and testing of priority populations—including sexual partners and children of PLHIV—achieving the goal of ending HIV/AIDS by 2030 will be difficult [18]. Although index case family testing is a key strategy to identify those at highest risk, information regarding its prevalence and associated factors is limited in Ethiopia. No previous study has been conducted on family-based HIV index case testing in the Southern Nations, Nationalities, and People's Region (SNNPR) or specifically in Wolaita Zone, one of the most populous zones in southern Ethiopia. This study addresses that gap by providing evidence-based information for policymakers, health planners, and decision-makers to improve HIV case management, reduce morbidity and mortality, and enhance service delivery. General objective: To assess the prevalence and factors associated with family-based HIV index case testing utilization in Wolaita Zone, SNNPR, Ethiopia, 2023. Specific objectives: To assess the prevalence of HIV index case family testing in selected healthcare facilities in Wolaita Zone. To identify factors associated with family-based HIV index case testing utilization in Wolaita Zone. METHODS Study design and setting A facility-based cross-sectional study was conducted in Wolaita Zone, Southern Nations, Nationalities, and People's Region (SNNPR), Ethiopia. Wolaita Zone is bordered by Gamo Zone to the south, Omo River to the west, Kambata Tambaro to the northwest, Hadiya to the north, Oromia region to the northeast, Sidama region to the east, and Lake Abaya to the southeast. The administrative center is Soddo town. The zone has 63 health centers, 11 primary hospitals, 5 private hospitals, and 1 comprehensive specialized teaching hospital. The study was conducted at four selected health facilities: Wolaita Soddo University Comprehensive and Specialized Hospital, Dubbo Hospital, Soddo Health Center, and Boditi Health Center. Study period Data collection was conducted from November 2022 to May 30, 2023. Source and study population The source population comprised all people living with HIV (PLHIV) in Wolaita Zone who were currently receiving antiretroviral therapy (ART). The study population included all PLHIV on ART who were eligible for partner and family-based index case HIV testing services at the selected health facilities during the study period. Inclusion and exclusion criteria All PLHIV on ART who were eligible for partner and family-based index case testing (i.e., those with a sexual partner or children under 15 years of age) were included. Clients who were seriously ill or physically unable to participate in an interview during the data collection period were excluded. Sample size and sampling procedure The sample size was calculated using the single population proportion formula with the following assumptions: 95% confidence level (Zα/2 = 1.96), assumed proportion of eligible clients who tested their families (P = 0.49) from a previous study [19], 5% margin of error, and a total population of 3,138. The calculated sample size was 384. Since the total population was less than 10,000, a finite population correction was applied, yielding 343 participants. Adding 10% for non-response gave a final sample size of 377. A systematic random sampling technique was used. The sampling interval (k) was calculated as 3,138/377 ≈ 8. The first participant was selected by lottery, and every 8th eligible client was subsequently enrolled. The sample was proportionally allocated across the four health facilities based on their average monthly ART patient volume. A detailed schematic representation of the sampling procedure is provided in Supplementary Figure S1. Data collection instruments and procedures Data were collected using a pretested, interviewer-administered semi-structured questionnaire adapted from previous studies [19,20]. The questionnaire was developed in English, translated into Amharic, and back-translated to English to ensure consistency. It captured socio-demographic characteristics, health status, family-related factors (disclosure, discussion, partner and child testing), and health facility-related factors (counselling, trust, accessibility). The conceptual framework guiding the selection of variables is presented in Supplementary Figure S2. Four data collectors and two supervisors were trained for one day on study objectives, ethical principles, interviewing techniques, and data collection instruments. The principal investigator supervised data collection daily. Completed questionnaires were reviewed for completeness and consistency. Study variables The dependent variable was index case family testing for HIV (yes/no), defined as either a sexual partner or biological children under 15 years having ever been tested for HIV. Independent variables included socio-demographic factors (age, sex, residence, marital status, education, occupation, income), health status factors (duration on ART, CD4 count, WHO clinical stage), family-related factors (HIV status disclosure, discussion with family members), and health facility-related factors (counselling by health workers, trust in staff, accessibility). Operational definitions Eligible clients: PLHIV who had a sexual partner or children under 15 years, or both. Index case: An individual newly diagnosed as HIV-positive or already enrolled in HIV treatment services [21]. Families tested: Either partner or children under 15 years tested for HIV. Children: Individuals aged less than 15 years. Sexual partner: Any person with whom the index client had sexual contact at least once. Data analysis Data were entered into Epi-info version 7.2 and exported to SPSS version 26.0 for analysis. Descriptive statistics (frequencies, percentages, means, standard deviations) were computed. Bivariable logistic regression was performed to identify candidate variables (p < 0.25) for inclusion in the multivariable model. Multivariable binary logistic regression using backward stepwise elimination was then conducted to identify factors independently associated with index case family testing. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, and statistical significance was set at p 0.05 indicating good fit). Multicollinearity was checked using variance inflation factor (VIF 0.1). Ethical considerations All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was obtained from the Institutional Review Board of Saint Paul's Hospital Millennium Medical College (Reference number: SPHMMC/IRB/2022/123). Written informed consent was obtained from all individual participants included in the study after explaining the study purpose, procedures, risks, and benefits. Confidentiality was ensured by omitting personal identifiers. Participants were informed of their right to withdraw at any time without consequence. RESULTS Socio-demographic and health status of participants All 377 participants completed the study (response rate 100%). Mean age was 36.6 years (SD = 9.97; range 18–75). Females comprised 52.5% (n = 198). The majority resided in urban areas (73.7%, n = 278), were married (71.1%, n = 268), and had secondary education (41.6%, n = 157). Most participants (91.2%, n = 344) had been on ART for ≥12 months (Table 1). Table 1. Socio-demographic and health status of index HIV cases, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377) Variable Category Frequency Percent Sex Male 179 47.5 Female 198 52.5 Age in years 18–29 114 30.2 30–39 118 31.3 40–49 110 29.2 ≥50 35 9.3 Residence Urban 278 73.7 Rural 99 26.3 Marital status Married 268 71.1 Not married but has partner 34 9.0 Separated 26 6.9 Divorced 17 4.5 Widowed 32 8.5 Education Illiterate 52 13.8 Primary 90 23.9 Secondary 157 41.6 Diploma or above 78 20.7 Occupation Student 26 6.9 Employed 42 11.1 Merchant 74 19.6 Farmer 26 6.9 Daily labor 119 31.6 Other 90 23.9 Duration on ART <12 months 33 8.8 ≥12 months 344 91.2 Family-related characteristics Of 377 participants, 290 (76.9%) had disclosed their HIV status to family members, primarily to sexual partners (80.6%) and own children (51.7%). Additionally, 249 (66.0%) had discussed HIV testing with family members (Table 2). Among 315 participants with sexual partners, 276 (87.6%) had partners who tested for HIV, of whom 154 (55.8%) were HIV-positive. Among 227 participants with children under 15 years, 213 (93.8%) had tested their children, with 48 (22.5%) having at least one child test positive (Table 2). Table 2. Family-related characteristics of index HIV cases, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377) Variable Category Frequency Percent HIV status disclosed to family Yes 290 76.9 No 87 23.1 To whom disclosed (n = 290) Sexual partner 234 80.6 Own children 150 51.7 Siblings 31 10.6 Parents 27 9.3 Discussed HIV testing with family Yes 249 66.0 No 128 34.0 Has sexual partner Yes 315 83.6 No 62 16.4 Partner tested for HIV (n = 315) Yes 276 87.6 No 19 6.0 Don't know 20 6.4 Partner HIV result (n = 276) Positive 154 55.8 Negative 122 44.2 Has children <15 years Yes 227 60.2 No 150 39.8 Children tested for HIV (n = 227) Yes 213 93.8 No 14 6.2 Health facility-related characteristics Most participants (96.0%) had HIV testing facilities near their residence. The majority preferred health worker referral (55.4%), health facility-based testing (93.4%), and regular work hours (87.8%). Most (92.0%) were counselled by health workers to bring families for testing, and 91.8% trusted health workers to maintain confidentiality (Table 3). Table 3. Health facility-related characteristics of index HIV cases, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377) Variable Category Frequency Percent HIV testing facility nearby Yes 362 96.0 No 15 4.0 Preferred referral means Client referral 57 15.1 Health worker referral 209 55.4 Dual referral 113 30.0 Contractual referral 9 2.4 Preferred testing place Health facility-based 352 93.4 Home-based 9 2.4 Community-based 16 4.2 Counselled by health workers Yes 347 92.0 No 30 8.0 Trust health workers for confidentiality Yes 346 91.8 No 31 8.2 Proportion of index case family testing Of 377 participants, 320 (84.9%; 95% CI: 81.2–88.6) had tested their family members for HIV (Figure 1). Factors associated with index case family testing In bivariable analysis, residence, marital status, duration since HIV diagnosis, duration on ART, CD4 count, media exposure, HIV status disclosure, discussion with family, availability of testing facilities, trust in health workers, and counselling by health workers were candidates for multivariable analysis (p < 0.25). In multivariable analysis, five factors remained significantly associated with index case family testing (Table 4): Urban residence: AOR = 2.8 (95% CI: 1.16–6.75) ART duration ≥12 months: AOR = 13.0 (95% CI: 4.6–36.9) HIV status disclosure: AOR = 5.6 (95% CI: 1.9–16.5) Discussion with family: AOR = 6.6 (95% CI: 1.9–23.2) Counselling by health workers: AOR = 6.3 (95% CI: 2.1–19.0) The Hosmer-Lemeshow test indicated good model fit (χ² = 3.15, df = 8, p = 0.67). No multicollinearity was detected (VIF < 5 for all variables). Table 4. Bivariable and multivariable analysis of factors associated with index case family testing, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377) Variable Category Family tested COR (95% CI) AOR (95% CI) p-value Yes (n=320) No (n=57) Residence Urban 240 38 1.5 (0.8–2.7) 2.8 (1.16–6.75) 0.023 Rural 80 19 1 1 Duration on ART ≥12 months 311 33 25.0 (10.7–58.5) 13.1 (4.6–36.9) <0.001 <12 months 9 24 1 1 HIV status disclosed Yes 278 12 24.8 (12.1–50.7) 5.6 (1.9–16.5) 0.002 No 42 45 1 1 Discussed HIV status with family Yes 243 6 26.8 (11.0–64.9) 6.6 (1.8–23.2) 0.004 No 77 51 1 1 Counselled by health workers Yes 304 43 6.1 (2.8–13.5) 6.3 (2.1–19.0) 0.001 No 16 14 1 1 *Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval. Bold values indicate statistical significance at p < 0.05. Model fit: Hosmer-Lemeshow χ² = 3.15, df = 8, p = 0.67.* DISCUSSION This study assessed the prevalence and factors associated with family-based HIV index case testing among adults on ART in Wolaita Zone, Southern Ethiopia. The proportion of index case family testing was 84.9% (95% CI: 81.2–88.6). Urban residence, duration on ART greater than 12 months, disclosure of HIV status to family members, discussion of HIV status with family members, and being counselled by health professionals to bring families for testing were significantly associated with index case family testing. Prevalence of index case family testing The proportion of index case family testing (84.9%; 95% CI: 81.2–88.6) is higher than reports from Kule Refugee Camp, Southwest Ethiopia (49%) [19], Felege Hiwot Referral Hospital, Bahir Dar (74.2%) [22], Uganda (72%) [23], and Kenya (62%) [24]. However, it is lower than findings from Woliso Town, Oromia, Ethiopia (94%) [20] and Tanzania (96.0%) [25]. This variation may be explained by differences in sampling methods, study populations, healthcare settings, and participant characteristics [19]. Notably, the 84.9% prevalence falls short of Ethiopia's national 95% target for index case testing modalities [26], indicating room for improvement. Urban versus rural residence Urban residents were nearly three times more likely to have tested their family members than rural residents (AOR = 2.8; 95% CI: 1.16–6.75). This finding aligns with a study in eastern Ethiopia, where urban residence was associated with 34 times higher odds of HIV testing [27]. Similarly, a multi-country study across 29 sub-Saharan African countries found consistently higher HIV testing uptake in urban areas [28]. Possible explanations include better accessibility of VCT centers, greater availability of health facilities, higher literacy rates, and reduced stigma in urban settings. Disclosure of HIV status Index clients who disclosed their HIV status to family members were 5.6 times more likely to have their families tested (AOR = 5.6; 95% CI: 1.9–16.5). This is consistent with studies from Woliso, Ethiopia (AOR = 7.2) [20], Uganda [29], and Zambia [30]. Disclosure likely facilitates open communication about HIV, reduces fear and stigma, and enables family members to make informed decisions about testing. Conversely, non-disclosure—often driven by fear of stigma, rejection, or intimate partner violence—remains a major barrier [31]. Discussion about HIV testing with family members Participants who discussed HIV testing with their families were 6.6 times more likely to test their families (AOR = 6.6; 95% CI: 1.9–23.2). Similar associations were reported in Mekelle Hospital, Ethiopia [32], and Nairobi, Kenya [33]. Discussion creates a supportive environment, normalizes testing, and directly prompts action. Duration on antiretroviral therapy Clients on ART for more than 12 months were 13 times more likely to test their families than those on ART for less than 12 months (AOR = 13.0; 95% CI: 4.6–36.9). This finding mirrors studies from Côte d'Ivoire [34], Kenya, and Uganda [35]. Newly initiated clients often experience higher levels of self-perceived stigma, fear of discrimination, and psychological distress. Over time, as clients adjust to their diagnosis, adhere to treatment, and build trust with healthcare providers, they become more willing to disclose and refer family members for testing [36]. Counselling by health professionals Participants counselled by health workers to bring their families for testing were 6.3 times more likely to test their families (AOR = 6.3; 95% CI: 2.1–19.0). Similar results were reported in Tanzania [37]. Effective counselling provides comprehensive information about the importance of tracing and testing sexual partners, children, and other family members. Counsellors can help PLHIV overcome fear, choose preferred referral methods, and develop practical plans for family testing [36]. Reasons for non-testing and non-disclosure Among participants who did not test their families, the major reasons for non-disclosure to partners included fear of perceived self-stigma (75.3%), fear of divorce or separation (24.6%), and fear of intimate partner violence (11.1%). Among those who did not disclose to children, the main reasons were not wanting to worry their children (49.3%) and believing children would not understand (32.4%). These findings highlight the need for targeted counselling interventions. Limitations This study has several limitations. First, the cross-sectional design precludes causal inference. Second, data on family member testing were based on participant self-report, which may introduce social desirability and recall bias. Third, the study was conducted in only four health facilities, limiting generalizability to other settings. Fourth, HIV testing status of family members was based on participant self-report and was not independently verified, which may introduce social desirability and recall bias. Despite these limitations, this is the first study to examine family-based index case testing in Wolaita Zone and provides important baseline data for the region. CONCLUSION The proportion of family-based HIV index case testing in Wolaita Zone was 84.9% (95% CI: 81.2–88.6), below the national 95% target. Urban residence, longer ART duration (≥12 months), HIV status disclosure to family members, discussion of HIV status with family members, and counselling by health professionals were significantly associated with testing uptake. Fear of self-stigma, divorce, and intimate partner violence were major barriers to disclosure and testing. Recommendations: Health facilities should strengthen counselling programs that address fear and stigma, particularly for newly initiated ART clients, as these factors were associated with higher testing uptake. Health workers should actively counsel index cases to disclose their status, discuss testing with family members, and refer families for testing. Policymakers should prioritize index case testing services in all governmental and private health facilities, with special attention to rural areas. Further qualitative and quantitative studies are needed across different zones and regions to identify additional contextual factors. Abbreviations Abbreviation Meaning AOR Adjusted odds ratio ART Antiretroviral therapy CI Confidence interval HIV Human immunodeficiency virus PLHIV People living with HIV SNNPR Southern Nations, Nationalities, and People's Region SPSS Statistical Package for the Social Sciences VCT Voluntary counselling and testing WHO World Health Organization Declarations Ethics approval and consent to participate: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was obtained from the Institutional Review Board of Saint Paul's Hospital Millennium Medical College (Reference number: SPHMMC/IRB/2022/123). Written informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable (no individual person's data). Availability of data and materials: The datasets used and analyzed during this study are available from the corresponding author upon reasonable request. Competing interests: The authors declare no competing interests. Funding: This study was self-funded by the author. No external funding was received. Authors' contributions: ABK conceived the study, designed the methodology, collected data, analyzed data, and drafted the manuscript. FM and TE supervised the study, reviewed the analysis, and critically revised the manuscript. All authors read and approved the final manuscript. Clinical trial number: not applicable. Acknowledgements: The authors thank Saint Paul's Hospital Millennium Medical College, the Southern Public Health Institute, Wolaita Zone Health Department, and the selected health facilities for their cooperation. We are also grateful to the data collectors, supervisors, and all study participants. References UNAIDS. Global HIV Statistics. Fact Sheet 2021. Geneva: UNAIDS; 2021. p. 1-3. Heath K, Levi J, Hill A. The Joint United Nations Programme on HIV/AIDS 95-95-95 targets: worldwide clinical and cost benefits of generic manufacture. AIDS. 2021;35(Suppl 2):S197-203. Jubilee M, Park FJ, Chipango K, Pule K, Machinda A, Tarubebereka N. HIV index testing to improve HIV positivity rate and linkage to care and treatment of sexual partners, adolescents and children of PLHIV in Lesotho. PLoS One. 2019;14(3):1-12. Belato DT, Mekiso AB, Begashaw B. Male partners involvement in prevention of mother-to-child transmission of HIV services in Southern Central Ethiopia: In case of Lemo District, Hadiya Zone. AIDS Res Treat. 2017;2017:1-7. Kamanga J, Stankevitz K, Martinez A, Chiegil R, Nyirenda L, Mulenga F, et al. Improved HIV case finding among key populations after differentiated data driven community testing approaches in Zambia. PLoS One. 2021;16(12):1-13. Khongonyowa L, Schouten E, Auld A. Malawi District Health System Strengthening and Quality Improvement for Service Delivery. Strategy for Achieving HIV. Msh. 2018;I(June):1-2. Johnson C. Consolidated Guidelines on HIV Testing Services: 5Cs: Consent, Confidentiality, Counselling, Correct Results and Connection. Geneva: World Health Organization; 2015. p. 163. Jerene D, Abebe W. HIV Testing Services HIV Self-Testing and Partner. Addis Ababa: Ministry of Health Ethiopia; 2017. p. 7. Lewis Kulzer J, Penner JA, Marima R, Oyaro P, Oyanga AO, Shade SB, et al. Family model of HIV care and treatment: A retrospective study in Kenya. J Int AIDS Soc. 2012;15(1):8. Federal Democratic Republic of Ethiopia Ministry of Health. National Quality Improvement Strategy. Addis Ababa: FMOH; 2018. Ahmed S, Sabelli RA, Simon K, Rosenberg NE, Kavuta E, Harawa M, et al. Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi. Trop Med Int Health. 2017;22(8):1021-9. Lowenthal E, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14(7):627-39. Harichund C, Moshabela M. Acceptability of HIV Self-Testing in Sub-Saharan Africa: Scoping Study. AIDS Behav. 2018;22(2):560-8. Central Statistical Agency Ethiopia. Ethiopia Demographic and Health Survey 2016. Addis Ababa: CSA; 2016. Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013;13:220. Exner T, Kelvin E, Ramjee G. Socio-demographic Factors Associated with Uptake of HIV Counseling and Testing (HCT) among Nigerian Youth. J AIDS Clin Res. 2014;5(10):1-2. Wegu Y, Sileshi T, Melis T. Assessment of Index Case Family Testing Among Adults Attending Art Clinic at Kule Refugee Camp, Southwest Ethiopia: 2021. HIV/AIDS - Res Palliat Care. 2022;14:13-21. World Health Organization Regional Office for Africa. End HIV/AIDS by 2030. Brazzaville: WHO AFRO; 2014. Wegu Y, Sileshi T, Melis T. Assessment of Index Case Family Testing Among Adults Attending Art Clinic at Kule Refugee Camp, Southwest Ethiopia: 2021. HIV/AIDS - Res Palliat Care. 2022;14:13-21. Haile T, Gulema H. Assessment of the proportion and the factors associated with partner and family based index case HIV testing in Woloso town, Oromia, Ethiopia: a cross-sectional study. 2020:1-21. WHO, PEPFAR, CDC. Partner and Family-Based Index Case Testing. Geneva: World Health Organization; 2015. p. 42. Gebresillassie BM, Emiru YK, Erku DA, Mersha AG, Mekuria AB, Ayele AA, et al. Utilization of Provider-Initiated HIV Testing and Counseling as an Intervention for PMTCT Services Among Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Ethiopia. Front Public Health. 2019;7:1-6. Were WA, Mermin JH, Wamai N, Awor AC, Bechange S, Moss S, et al. Undiagnosed HIV infection and couple HIV discordance among household members of HIV-infected people receiving antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr. 2006;43(1):91-5. Wagner AD, Mugo C, Njuguna IN, Maleche-Obimbo E, Sherr K, Inwani IW, et al. Implementation and operational research: Active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. J Acquir Immune Defic Syndr. 2016;73(5):e83-9. Sanga Z, Kapanda G, Msuya S, Mwangi R. Factors influencing the uptake of Voluntary HIV Counseling and Testing among secondary school students in Arusha City, Tanzania: A cross sectional study. BMC Public Health. 2015;15(1):1-9. Federal HIV/AIDS Prevention and Control Office. HIV/AIDS National Strategic Plan for Ethiopia 2021-2025. Addis Ababa: FHAPCO; 2021. Tesfaye G, Dessie Y, Berhane Y, Assefa N, Semahegn A, Canavan CR, et al. HIV/AIDS awareness and testing practices among adolescents in eastern Ethiopia. Trop Med Int Health. 2020;25(1):111-8. Staveteig S, Wang S, Head SK, Bradley SEK, Nybro E. Demographic patterns of HIV testing uptake in sub-Saharan Africa. DHS Comparative Reports No. 30. Calverton: ICF International; 2013. p. 81. Nabunya P, Byansi W, Sensoy Bahar O, McKay M, Ssewamala FM, Damulira C. Factors Associated With HIV Disclosure and HIV-Related Stigma Among Adolescents Living With HIV in Southwestern Uganda. Front Psychiatry. 2020;11:1-10. Aluisio AR, Bosire R, Bourke B, Gatuguta A, Kiarie JN, Nduati R, et al. Male partner participation in antenatal clinic services is associated with improved HIV-free survival among infants in Nairobi, Kenya: A prospective cohort study. J Acquir Immune Defic Syndr. 2016;73(2):169-76. Turan JM, Bukusi EA, Onono M, Holzerner WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: Results from the MAMAS study. AIDS Behav. 2011;15(6):1111-20. Alemayehu M. The Role of Male Partner Involvement on Mother's Adherence to PMTCT Care and Support, Tigray, Northern Ethiopia. Fam Med Med Sci Res. 2014;3(4):4-10. Aluisio AR, Bosire R, Bourke B, Gatuguta A, Kiarie JN, Nduati R, et al. Male partner participation in antenatal clinic services is associated with improved HIV-free survival among infants in Nairobi, Kenya: A prospective cohort study. J Acquir Immune Defic Syndr. 2016;73(2):169-76. Doumatey NIL, Ekra AK, Ebah LG, Kouame H. Outcome of HIV Testing Among Family Members of Index Cases Across 36 Facilities in Abidjan, Cote d'Ivoire. AIDS Behav. 2021;25(2):554-61. Penfold S, Simms V, Downing J, Powell RA, Mwangi-Powell F, Namasango E, et al. The HIV basic care package: where is it available and who receives it? Findings from a mixed methods evaluation in Kenya and Uganda. AIDS Care. 2014;26(9):1155-63. Edosa M, Merdassa E, Turi E. Acceptance of Index Case HIV Testing and Its Associated Factors Among HIV/AIDS Clients on ART Follow-Up in West Ethiopia: A Multi-Centered Facility-Based Cross-Sectional Study. HIV/AIDS - Res Palliat Care. 2022;14:451-60. Gitige CG, Kweisigabo GP, Panga OD, Samizi FG, Abade AM, Mbelele PM, et al. Factors associated with Partners Elicitation during HIV Index client's testing in Dar es Salaam Region, Tanzania. J Interv Epidemiol Public Health. 2021;4(3). Additional Declarations No competing interests reported. Supplementary Files AsratBoshaSupplementaryquestionnaire.docx AsratBoshaSupplementaryFile1.pdf AsratBoshaSupplementaryFile2.pdf SFig3.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9321469","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622521637,"identity":"2e9c583e-2e54-4128-ab1c-207c1f80200c","order_by":0,"name":"Asrat Bosha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYLACxgYGBgMGxsYHH4AcNnZitBwEa2FuNpwB0sJMvBb2NmkeEI+QFv7+sw8/f9xhY2/OfrBB2ubXNnk+ZgbGDx9zcGuRuJFuLHHwTFrizp7EBuPcvtuGbcwMzJIzt+Gx5gYbg8TBtsMJBgcSG5Jze24zArWwMfPi0SJ//hjzD6AWe4PzDxsOW/bctieoxeBAGhvIFsYNNxIbmxl+3E4kqMXwRhqbxVmgXzbceNjM2NtwO7mNmbEZr1/kgA67UQkMMYPz6c9//Phz23Z+e/PBDx/xeR8FMLaByQZi1YPAH1IUj4JRMApGwUgBACfxWP9xg3YvAAAAAElFTkSuQmCC","orcid":"","institution":"Saint Paul's Hospital Millennium Medical College","correspondingAuthor":true,"prefix":"","firstName":"Asrat","middleName":"","lastName":"Bosha","suffix":""},{"id":622521638,"identity":"05571baa-3741-455a-b084-984aa8c4bcf0","order_by":1,"name":"Fatimetu Mohammed","email":"","orcid":"","institution":"Saint Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Fatimetu","middleName":"","lastName":"Mohammed","suffix":""},{"id":622521639,"identity":"c74e3cc7-a92f-4057-a642-c4f7b960ec57","order_by":2,"name":"Tewodros Eshete","email":"","orcid":"","institution":"Saint Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Tewodros","middleName":"","lastName":"Eshete","suffix":""}],"badges":[],"createdAt":"2026-04-04 15:09:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9321469/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9321469/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107258579,"identity":"a05b307e-505f-48ef-b4d5-6b29ed7788f8","added_by":"auto","created_at":"2026-04-19 12:39:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10933,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportion of family-based HIV index case testing among adults on antiretroviral therapy (ART) in Wolaita Zone, Southern Ethiopia, 2023 (N = 377)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9321469/v1/d637800af39535992e3970a3.png"},{"id":107258804,"identity":"5f7537b6-a564-4cfc-a6c0-726d62b83145","added_by":"auto","created_at":"2026-04-19 12:40:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1082534,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9321469/v1/23f060a4-0c26-489b-b858-3dc4f49bfb5c.pdf"},{"id":107258708,"identity":"e32a2933-4eca-4fc4-b422-194f780e9f08","added_by":"auto","created_at":"2026-04-19 12:40:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21097,"visible":true,"origin":"","legend":"","description":"","filename":"AsratBoshaSupplementaryquestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-9321469/v1/cb10f51601e428b8dc76152f.docx"},{"id":107258556,"identity":"56aebe63-7566-4941-8456-dca52c22dbd7","added_by":"auto","created_at":"2026-04-19 12:39:44","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":181064,"visible":true,"origin":"","legend":"","description":"","filename":"AsratBoshaSupplementaryFile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9321469/v1/a4feea61ee85920980a2d87a.pdf"},{"id":107258595,"identity":"63d7254c-2645-4752-a251-bfbecadb471f","added_by":"auto","created_at":"2026-04-19 12:39:52","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":221610,"visible":true,"origin":"","legend":"","description":"","filename":"AsratBoshaSupplementaryFile2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9321469/v1/15659bed8926a9be7c63f272.pdf"},{"id":107258596,"identity":"2d47fe2a-94f3-4f9d-8efd-92e8ef373ffa","added_by":"auto","created_at":"2026-04-19 12:39:52","extension":"pdf","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":134473,"visible":true,"origin":"","legend":"","description":"","filename":"SFig3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9321469/v1/94ac31618db0177d160ec73f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Factors Associated with Family-Based HIV Index Case Testing in Wolaita Zone, Southern Ethiopia, 2023: A Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe human immunodeficiency virus (HIV) continues to be a major global public health concern. In 2021, an estimated 38.4 million people were living with HIV worldwide, with approximately 650,000 AIDS-related deaths and 4,000 new infections daily [1]. The Joint United Nations Programme on HIV/AIDS (UNAIDS) established the 95-95-95 targets aiming to diagnose 95% of all HIV-positive individuals, provide antiretroviral therapy (ART) to 95% of those diagnosed, and achieve viral suppression in 95% of those treated by 2030 [2]. However, an estimated 40% of people living with HIV (PLHIV) remain undiagnosed globally [3].\u003c/p\u003e\n\u003cp\u003eHIV testing and counselling is a critical gateway to ART access, which reduces morbidity, mortality, and HIV transmission through viral suppression [4]. While traditional facility-based testing approaches such as voluntary counselling and testing (VCT) and provider-initiated testing and counselling (PITC) have been widely implemented, alternative strategies are needed to reach undiagnosed populations. Index case testing—where a person with confirmed HIV infection is asked to contact family members, including children, spouses, sexual partners, siblings, and parents for HIV testing—has demonstrated higher positivity rates compared to other testing methods [5,6].\u003c/p\u003e\n\u003cp\u003eThe World Health Organization recommends targeted HIV testing strategies such as index-linked testing to improve efficiency and reduce costs [7]. Index testing has proven effective in several sub-Saharan African countries, including Ethiopia, for identifying and enrolling previously undiagnosed individuals into ART [8,9]. The Ethiopian government has implemented index testing as part of its national HIV strategic plan [10].\u003c/p\u003e\n\u003cp\u003eDespite these efforts, evidence from sub-Saharan Africa, including Ethiopia, indicates that only 32–55% of adolescents are ever tested for HIV, and delayed diagnosis increases both further HIV transmission and mortality risk [11,12]. Barriers to testing include stigma, discrimination, and lack of confidential testing environments [13]. A recent population-based survey in Ethiopia found that only 40% of women had been previously tested, suggesting a substantial proportion of HIV-seropositive individuals remain unaware of their status [14].\u003c/p\u003e\n\u003cp\u003ePrevious studies have identified age, residence, education, wealth, condom use, healthcare access, HIV knowledge, and substance use as factors affecting HIV testing. However, these factors vary across populations, countries, and regions [15,16]. Up to 70% of partners and family members of PLHIV are also HIV-positive, yet many remain untested [17]. Without targeted identification and testing of priority populations—including sexual partners and children of PLHIV—achieving the goal of ending HIV/AIDS by 2030 will be difficult [18].\u003c/p\u003e\n\u003cp\u003eAlthough index case family testing is a key strategy to identify those at highest risk, information regarding its prevalence and associated factors is limited in Ethiopia. No previous study has been conducted on family-based HIV index case testing in the Southern Nations, Nationalities, and People's Region (SNNPR) or specifically in Wolaita Zone, one of the most populous zones in southern Ethiopia. This study addresses that gap by providing evidence-based information for policymakers, health planners, and decision-makers to improve HIV case management, reduce morbidity and mortality, and enhance service delivery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral objective:\u003c/strong\u003e To assess the prevalence and factors associated with family-based HIV index case testing utilization in Wolaita Zone, SNNPR, Ethiopia, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpecific objectives:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eTo assess the prevalence of HIV index case family testing in selected healthcare facilities in Wolaita Zone.\u003c/li\u003e\n \u003cli\u003eTo identify factors associated with family-based HIV index case testing utilization in Wolaita Zone.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA facility-based cross-sectional study was conducted in Wolaita Zone, Southern Nations, Nationalities, and People's Region (SNNPR), Ethiopia. Wolaita Zone is bordered by Gamo Zone to the south, Omo River to the west, Kambata Tambaro to the northwest, Hadiya to the north, Oromia region to the northeast, Sidama region to the east, and Lake Abaya to the southeast. The administrative center is Soddo town. The zone has 63 health centers, 11 primary hospitals, 5 private hospitals, and 1 comprehensive specialized teaching hospital. The study was conducted at four selected health facilities: Wolaita Soddo University Comprehensive and Specialized Hospital, Dubbo Hospital, Soddo Health Center, and Boditi Health Center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection was conducted from November 2022 to May 30, 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource and study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe source population comprised all people living with HIV (PLHIV) in Wolaita Zone who were currently receiving antiretroviral therapy (ART). The study population included all PLHIV on ART who were eligible for partner and family-based index case HIV testing services at the selected health facilities during the study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll PLHIV on ART who were eligible for partner and family-based index case testing (i.e., those with a sexual partner or children under 15 years of age) were included. Clients who were seriously ill or physically unable to participate in an interview during the data collection period were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using the single population proportion formula with the following assumptions: 95% confidence level (Zα/2 = 1.96), assumed proportion of eligible clients who tested their families (P = 0.49) from a previous study [19], 5% margin of error, and a total population of 3,138. The calculated sample size was 384. Since the total population was less than 10,000, a finite population correction was applied, yielding 343 participants. Adding 10% for non-response gave a final sample size of 377.\u003c/p\u003e\n\u003cp\u003eA systematic random sampling technique was used. The sampling interval (k) was calculated as 3,138/377 ≈ 8. The first participant was selected by lottery, and every 8th eligible client was subsequently enrolled. The sample was proportionally allocated across the four health facilities based on their average monthly ART patient volume. A detailed schematic representation of the sampling procedure is provided in Supplementary Figure S1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection instruments and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a pretested, interviewer-administered semi-structured questionnaire adapted from previous studies [19,20]. The questionnaire was developed in English, translated into Amharic, and back-translated to English to ensure consistency. It captured socio-demographic characteristics, health status, family-related factors (disclosure, discussion, partner and child testing), and health facility-related factors (counselling, trust, accessibility). The conceptual framework guiding the selection of variables is presented in Supplementary Figure S2.\u003c/p\u003e\n\u003cp\u003eFour data collectors and two supervisors were trained for one day on study objectives, ethical principles, interviewing techniques, and data collection instruments. The principal investigator supervised data collection daily. Completed questionnaires were reviewed for completeness and consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dependent variable was index case family testing for HIV (yes/no), defined as either a sexual partner or biological children under 15 years having ever been tested for HIV. Independent variables included socio-demographic factors (age, sex, residence, marital status, education, occupation, income), health status factors (duration on ART, CD4 count, WHO clinical stage), family-related factors (HIV status disclosure, discussion with family members), and health facility-related factors (counselling by health workers, trust in staff, accessibility).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eEligible clients:\u003c/strong\u003e PLHIV who had a sexual partner or children under 15 years, or both.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIndex case:\u003c/strong\u003e An individual newly diagnosed as HIV-positive or already enrolled in HIV treatment services [21].\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFamilies tested:\u003c/strong\u003e Either partner or children under 15 years tested for HIV.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eChildren:\u003c/strong\u003e Individuals aged less than 15 years.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSexual partner:\u003c/strong\u003e Any person with whom the index client had sexual contact at least once.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered into Epi-info version 7.2 and exported to SPSS version 26.0 for analysis. Descriptive statistics (frequencies, percentages, means, standard deviations) were computed. Bivariable logistic regression was performed to identify candidate variables (p \u0026lt; 0.25) for inclusion in the multivariable model. Multivariable binary logistic regression using backward stepwise elimination was then conducted to identify factors independently associated with index case family testing. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, and statistical significance was set at p \u0026lt; 0.05. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test (p \u0026gt; 0.05 indicating good fit). Multicollinearity was checked using variance inflation factor (VIF \u0026lt; 5) and tolerance (\u0026gt; 0.1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was obtained from the Institutional Review Board of Saint Paul's Hospital Millennium Medical College (Reference number: SPHMMC/IRB/2022/123). Written informed consent was obtained from all individual participants included in the study after explaining the study purpose, procedures, risks, and benefits. Confidentiality was ensured by omitting personal identifiers. Participants were informed of their right to withdraw at any time without consequence.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic and health status of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 377 participants completed the study (response rate 100%). Mean age was 36.6 years (SD = 9.97; range 18\u0026ndash;75). Females comprised 52.5% (n = 198). The majority resided in urban areas (73.7%, n = 278), were married (71.1%, n = 268), and had secondary education (41.6%, n = 157). Most participants (91.2%, n = 344) had been on ART for \u0026ge;12 months (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Socio-demographic and health status of index HIV cases, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"629\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNot married but has partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiploma or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDaily labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on ART\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFamily-related characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 377 participants, 290 (76.9%) had disclosed their HIV status to family members, primarily to sexual partners (80.6%) and own children (51.7%). Additionally, 249 (66.0%) had discussed HIV testing with family members (Table 2).\u003c/p\u003e\n\u003cp\u003eAmong 315 participants with sexual partners, 276 (87.6%) had partners who tested for HIV, of whom 154 (55.8%) were HIV-positive. Among 227 participants with children under 15 years, 213 (93.8%) had tested their children, with 48 (22.5%) having at least one child test positive (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Family-related characteristics of index HIV cases, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"651\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV status disclosed to family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTo whom disclosed (n = 290)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSexual partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOwn children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSiblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eParents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscussed HIV testing with family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas sexual partner\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner tested for HIV (n = 315)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDon\u0026apos;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner HIV result (n = 276)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas children \u0026lt;15 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChildren tested for HIV (n = 227)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eHealth facility-related characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants (96.0%) had HIV testing facilities near their residence. The majority preferred health worker referral (55.4%), health facility-based testing (93.4%), and regular work hours (87.8%). Most (92.0%) were counselled by health workers to bring families for testing, and 91.8% trusted health workers to maintain confidentiality (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Health facility-related characteristics of index HIV cases, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV testing facility nearby\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreferred referral means\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eClient referral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth worker referral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDual referral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eContractual referral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreferred testing place\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth facility-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e93.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHome-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCommunity-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCounselled by health workers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrust health workers for confidentiality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e91.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eProportion of index case family testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 377 participants, 320 (84.9%; 95% CI: 81.2\u0026ndash;88.6) had tested their family members for HIV (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with index case family testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn bivariable analysis, residence, marital status, duration since HIV diagnosis, duration on ART, CD4 count, media exposure, HIV status disclosure, discussion with family, availability of testing facilities, trust in health workers, and counselling by health workers were candidates for multivariable analysis (p \u0026lt; 0.25).\u003c/p\u003e\n\u003cp\u003eIn multivariable analysis, five factors remained significantly associated with index case family testing (Table 4):\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eUrban residence: AOR = 2.8 (95% CI: 1.16\u0026ndash;6.75)\u003c/li\u003e\n \u003cli\u003eART duration \u0026ge;12 months: AOR = 13.0 (95% CI: 4.6\u0026ndash;36.9)\u003c/li\u003e\n \u003cli\u003eHIV status disclosure: AOR = 5.6 (95% CI: 1.9\u0026ndash;16.5)\u003c/li\u003e\n \u003cli\u003eDiscussion with family: AOR = 6.6 (95% CI: 1.9\u0026ndash;23.2)\u003c/li\u003e\n \u003cli\u003eCounselling by health workers: AOR = 6.3 (95% CI: 2.1\u0026ndash;19.0)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe Hosmer-Lemeshow test indicated good model fit (\u0026chi;\u0026sup2; = 3.15, df = 8, p = 0.67). No multicollinearity was detected (VIF \u0026lt; 5 for all variables).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Bivariable and multivariable analysis of factors associated with index case family testing, Wolaita Zone, SNNPR, Ethiopia, 2023 (N = 377)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily tested\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes (n=320)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo (n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.5 (0.8\u0026ndash;2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.8 (1.16\u0026ndash;6.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on ART\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.0 (10.7\u0026ndash;58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.1 (4.6\u0026ndash;36.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV status disclosed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.8 (12.1\u0026ndash;50.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.6 (1.9\u0026ndash;16.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiscussed HIV status with family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26.8 (11.0\u0026ndash;64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.6 (1.8\u0026ndash;23.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCounselled by health workers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.1 (2.8\u0026ndash;13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.3 (2.1\u0026ndash;19.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Abbreviations: AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval. Bold values indicate statistical significance at p \u0026lt; 0.05. Model fit: Hosmer-Lemeshow \u0026chi;\u0026sup2; = 3.15, df = 8, p = 0.67.*\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study assessed the prevalence and factors associated with family-based HIV index case testing among adults on ART in Wolaita Zone, Southern Ethiopia. The proportion of index case family testing was 84.9% (95% CI: 81.2–88.6). Urban residence, duration on ART greater than 12 months, disclosure of HIV status to family members, discussion of HIV status with family members, and being counselled by health professionals to bring families for testing were significantly associated with index case family testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of index case family testing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proportion of index case family testing (84.9%; 95% CI: 81.2–88.6) is higher than reports from Kule Refugee Camp, Southwest Ethiopia (49%) [19], Felege Hiwot Referral Hospital, Bahir Dar (74.2%) [22], Uganda (72%) [23], and Kenya (62%) [24]. However, it is lower than findings from Woliso Town, Oromia, Ethiopia (94%) [20] and Tanzania (96.0%) [25]. This variation may be explained by differences in sampling methods, study populations, healthcare settings, and participant characteristics [19]. Notably, the 84.9% prevalence falls short of Ethiopia's national 95% target for index case testing modalities [26], indicating room for improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUrban versus rural residence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUrban residents were nearly three times more likely to have tested their family members than rural residents (AOR = 2.8; 95% CI: 1.16–6.75). This finding aligns with a study in eastern Ethiopia, where urban residence was associated with 34 times higher odds of HIV testing [27]. Similarly, a multi-country study across 29 sub-Saharan African countries found consistently higher HIV testing uptake in urban areas [28]. Possible explanations include better accessibility of VCT centers, greater availability of health facilities, higher literacy rates, and reduced stigma in urban settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of HIV status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndex clients who disclosed their HIV status to family members were 5.6 times more likely to have their families tested (AOR = 5.6; 95% CI: 1.9–16.5). This is consistent with studies from Woliso, Ethiopia (AOR = 7.2) [20], Uganda [29], and Zambia [30]. Disclosure likely facilitates open communication about HIV, reduces fear and stigma, and enables family members to make informed decisions about testing. Conversely, non-disclosure—often driven by fear of stigma, rejection, or intimate partner violence—remains a major barrier [31].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion about HIV testing with family members\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants who discussed HIV testing with their families were 6.6 times more likely to test their families (AOR = 6.6; 95% CI: 1.9–23.2). Similar associations were reported in Mekelle Hospital, Ethiopia [32], and Nairobi, Kenya [33]. Discussion creates a supportive environment, normalizes testing, and directly prompts action.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDuration on antiretroviral therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClients on ART for more than 12 months were 13 times more likely to test their families than those on ART for less than 12 months (AOR = 13.0; 95% CI: 4.6–36.9). This finding mirrors studies from Côte d'Ivoire [34], Kenya, and Uganda [35]. Newly initiated clients often experience higher levels of self-perceived stigma, fear of discrimination, and psychological distress. Over time, as clients adjust to their diagnosis, adhere to treatment, and build trust with healthcare providers, they become more willing to disclose and refer family members for testing [36].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCounselling by health professionals\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants counselled by health workers to bring their families for testing were 6.3 times more likely to test their families (AOR = 6.3; 95% CI: 2.1–19.0). Similar results were reported in Tanzania [37]. Effective counselling provides comprehensive information about the importance of tracing and testing sexual partners, children, and other family members. Counsellors can help PLHIV overcome fear, choose preferred referral methods, and develop practical plans for family testing [36].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReasons for non-testing and non-disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong participants who did not test their families, the major reasons for non-disclosure to partners included fear of perceived self-stigma (75.3%), fear of divorce or separation (24.6%), and fear of intimate partner violence (11.1%). Among those who did not disclose to children, the main reasons were not wanting to worry their children (49.3%) and believing children would not understand (32.4%). These findings highlight the need for targeted counselling interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, the cross-sectional design precludes causal inference. Second, data on family member testing were based on participant self-report, which may introduce social desirability and recall bias. Third, the study was conducted in only four health facilities, limiting generalizability to other settings. Fourth, HIV testing status of family members was based on participant self-report and was not independently verified, which may introduce social desirability and recall bias. Despite these limitations, this is the first study to examine family-based index case testing in Wolaita Zone and provides important baseline data for the region.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe proportion of family-based HIV index case testing in Wolaita Zone was 84.9% (95% CI: 81.2\u0026ndash;88.6), below the national 95% target. Urban residence, longer ART duration (\u0026ge;12 months), HIV status disclosure to family members, discussion of HIV status with family members, and counselling by health professionals were significantly associated with testing uptake. Fear of self-stigma, divorce, and intimate partner violence were major barriers to disclosure and testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eHealth facilities should strengthen counselling programs that address fear and stigma, particularly for newly initiated ART clients, as these factors were associated with higher testing uptake.\u003c/li\u003e\n \u003cli\u003eHealth workers should actively counsel index cases to disclose their status, discuss testing with family members, and refer families for testing.\u003c/li\u003e\n \u003cli\u003ePolicymakers should prioritize index case testing services in all governmental and private health facilities, with special attention to rural areas.\u003c/li\u003e\n \u003cli\u003eFurther qualitative and quantitative studies are needed across different zones and regions to identify additional contextual factors.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"752\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAbbreviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMeaning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdjusted odds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eART\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAntiretroviral therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eConfidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePLHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePeople living with HIV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSNNPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSouthern Nations, Nationalities, and People\u0026apos;s Region\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVoluntary counselling and testing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Ethical approval was obtained from the Institutional Review Board of Saint Paul's Hospital Millennium Medical College (Reference number: SPHMMC/IRB/2022/123). Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable (no individual person's data).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and analyzed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was self-funded by the author. No external funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e ABK conceived the study, designed the methodology, collected data, analyzed data, and drafted the manuscript. FM and TE supervised the study, reviewed the analysis, and critically revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors thank Saint Paul's Hospital Millennium Medical College, the Southern Public Health Institute, Wolaita Zone Health Department, and the selected health facilities for their cooperation. We are also grateful to the data collectors, supervisors, and all study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNAIDS. Global HIV Statistics. Fact Sheet 2021. Geneva: UNAIDS; 2021. p. 1-3.\u003c/li\u003e\n\u003cli\u003eHeath K, Levi J, Hill A. The Joint United Nations Programme on HIV/AIDS 95-95-95 targets: worldwide clinical and cost benefits of generic manufacture. AIDS. 2021;35(Suppl 2):S197-203.\u003c/li\u003e\n\u003cli\u003eJubilee M, Park FJ, Chipango K, Pule K, Machinda A, Tarubebereka N. HIV index testing to improve HIV positivity rate and linkage to care and treatment of sexual partners, adolescents and children of PLHIV in Lesotho. PLoS One. 2019;14(3):1-12.\u003c/li\u003e\n\u003cli\u003eBelato DT, Mekiso AB, Begashaw B. Male partners involvement in prevention of mother-to-child transmission of HIV services in Southern Central Ethiopia: In case of Lemo District, Hadiya Zone. AIDS Res Treat. 2017;2017:1-7.\u003c/li\u003e\n\u003cli\u003eKamanga J, Stankevitz K, Martinez A, Chiegil R, Nyirenda L, Mulenga F, et al. Improved HIV case finding among key populations after differentiated data driven community testing approaches in Zambia. PLoS One. 2021;16(12):1-13.\u003c/li\u003e\n\u003cli\u003eKhongonyowa L, Schouten E, Auld A. Malawi District Health System Strengthening and Quality Improvement for Service Delivery. Strategy for Achieving HIV. Msh. 2018;I(June):1-2.\u003c/li\u003e\n\u003cli\u003eJohnson C. Consolidated Guidelines on HIV Testing Services: 5Cs: Consent, Confidentiality, Counselling, Correct Results and Connection. Geneva: World Health Organization; 2015. p. 163.\u003c/li\u003e\n\u003cli\u003eJerene D, Abebe W. HIV Testing Services HIV Self-Testing and Partner. Addis Ababa: Ministry of Health Ethiopia; 2017. p. 7.\u003c/li\u003e\n\u003cli\u003eLewis Kulzer J, Penner JA, Marima R, Oyaro P, Oyanga AO, Shade SB, et al. Family model of HIV care and treatment: A retrospective study in Kenya. J Int AIDS Soc. 2012;15(1):8.\u003c/li\u003e\n\u003cli\u003eFederal Democratic Republic of Ethiopia Ministry of Health. National Quality Improvement Strategy. Addis Ababa: FMOH; 2018.\u003c/li\u003e\n\u003cli\u003eAhmed S, Sabelli RA, Simon K, Rosenberg NE, Kavuta E, Harawa M, et al. Index case finding facilitates identification and linkage to care of children and young persons living with HIV/AIDS in Malawi. Trop Med Int Health. 2017;22(8):1021-9.\u003c/li\u003e\n\u003cli\u003eLowenthal E, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14(7):627-39.\u003c/li\u003e\n\u003cli\u003eHarichund C, Moshabela M. Acceptability of HIV Self-Testing in Sub-Saharan Africa: Scoping Study. AIDS Behav. 2018;22(2):560-8.\u003c/li\u003e\n\u003cli\u003eCentral Statistical Agency Ethiopia. Ethiopia Demographic and Health Survey 2016. Addis Ababa: CSA; 2016.\u003c/li\u003e\n\u003cli\u003eMusheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013;13:220.\u003c/li\u003e\n\u003cli\u003eExner T, Kelvin E, Ramjee G. Socio-demographic Factors Associated with Uptake of HIV Counseling and Testing (HCT) among Nigerian Youth. J AIDS Clin Res. 2014;5(10):1-2.\u003c/li\u003e\n\u003cli\u003eWegu Y, Sileshi T, Melis T. Assessment of Index Case Family Testing Among Adults Attending Art Clinic at Kule Refugee Camp, Southwest Ethiopia: 2021. HIV/AIDS - Res Palliat Care. 2022;14:13-21.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization Regional Office for Africa. End HIV/AIDS by 2030. Brazzaville: WHO AFRO; 2014.\u003c/li\u003e\n\u003cli\u003eWegu Y, Sileshi T, Melis T. Assessment of Index Case Family Testing Among Adults Attending Art Clinic at Kule Refugee Camp, Southwest Ethiopia: 2021. HIV/AIDS - Res Palliat Care. 2022;14:13-21.\u003c/li\u003e\n\u003cli\u003eHaile T, Gulema H. Assessment of the proportion and the factors associated with partner and family based index case HIV testing in Woloso town, Oromia, Ethiopia: a cross-sectional study. 2020:1-21.\u003c/li\u003e\n\u003cli\u003eWHO, PEPFAR, CDC. Partner and Family-Based Index Case Testing. Geneva: World Health Organization; 2015. p. 42.\u003c/li\u003e\n\u003cli\u003eGebresillassie BM, Emiru YK, Erku DA, Mersha AG, Mekuria AB, Ayele AA, et al. Utilization of Provider-Initiated HIV Testing and Counseling as an Intervention for PMTCT Services Among Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Ethiopia. Front Public Health. 2019;7:1-6.\u003c/li\u003e\n\u003cli\u003eWere WA, Mermin JH, Wamai N, Awor AC, Bechange S, Moss S, et al. Undiagnosed HIV infection and couple HIV discordance among household members of HIV-infected people receiving antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr. 2006;43(1):91-5.\u003c/li\u003e\n\u003cli\u003eWagner AD, Mugo C, Njuguna IN, Maleche-Obimbo E, Sherr K, Inwani IW, et al. Implementation and operational research: Active referral of children of HIV-positive adults reveals high prevalence of undiagnosed HIV. J Acquir Immune Defic Syndr. 2016;73(5):e83-9.\u003c/li\u003e\n\u003cli\u003eSanga Z, Kapanda G, Msuya S, Mwangi R. Factors influencing the uptake of Voluntary HIV Counseling and Testing among secondary school students in Arusha City, Tanzania: A cross sectional study. BMC Public Health. 2015;15(1):1-9.\u003c/li\u003e\n\u003cli\u003eFederal HIV/AIDS Prevention and Control Office. HIV/AIDS National Strategic Plan for Ethiopia 2021-2025. Addis Ababa: FHAPCO; 2021.\u003c/li\u003e\n\u003cli\u003eTesfaye G, Dessie Y, Berhane Y, Assefa N, Semahegn A, Canavan CR, et al. HIV/AIDS awareness and testing practices among adolescents in eastern Ethiopia. Trop Med Int Health. 2020;25(1):111-8.\u003c/li\u003e\n\u003cli\u003eStaveteig S, Wang S, Head SK, Bradley SEK, Nybro E. Demographic patterns of HIV testing uptake in sub-Saharan Africa. DHS Comparative Reports No. 30. Calverton: ICF International; 2013. p. 81.\u003c/li\u003e\n\u003cli\u003eNabunya P, Byansi W, Sensoy Bahar O, McKay M, Ssewamala FM, Damulira C. Factors Associated With HIV Disclosure and HIV-Related Stigma Among Adolescents Living With HIV in Southwestern Uganda. Front Psychiatry. 2020;11:1-10.\u003c/li\u003e\n\u003cli\u003eAluisio AR, Bosire R, Bourke B, Gatuguta A, Kiarie JN, Nduati R, et al. Male partner participation in antenatal clinic services is associated with improved HIV-free survival among infants in Nairobi, Kenya: A prospective cohort study. J Acquir Immune Defic Syndr. 2016;73(2):169-76.\u003c/li\u003e\n\u003cli\u003eTuran JM, Bukusi EA, Onono M, Holzerner WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: Results from the MAMAS study. AIDS Behav. 2011;15(6):1111-20.\u003c/li\u003e\n\u003cli\u003eAlemayehu M. The Role of Male Partner Involvement on Mother\u0026apos;s Adherence to PMTCT Care and Support, Tigray, Northern Ethiopia. Fam Med Med Sci Res. 2014;3(4):4-10.\u003c/li\u003e\n\u003cli\u003eAluisio AR, Bosire R, Bourke B, Gatuguta A, Kiarie JN, Nduati R, et al. Male partner participation in antenatal clinic services is associated with improved HIV-free survival among infants in Nairobi, Kenya: A prospective cohort study. J Acquir Immune Defic Syndr. 2016;73(2):169-76.\u003c/li\u003e\n\u003cli\u003eDoumatey NIL, Ekra AK, Ebah LG, Kouame H. Outcome of HIV Testing Among Family Members of Index Cases Across 36 Facilities in Abidjan, Cote d\u0026apos;Ivoire. AIDS Behav. 2021;25(2):554-61.\u003c/li\u003e\n\u003cli\u003ePenfold S, Simms V, Downing J, Powell RA, Mwangi-Powell F, Namasango E, et al. The HIV basic care package: where is it available and who receives it? Findings from a mixed methods evaluation in Kenya and Uganda. AIDS Care. 2014;26(9):1155-63.\u003c/li\u003e\n\u003cli\u003eEdosa M, Merdassa E, Turi E. Acceptance of Index Case HIV Testing and Its Associated Factors Among HIV/AIDS Clients on ART Follow-Up in West Ethiopia: A Multi-Centered Facility-Based Cross-Sectional Study. HIV/AIDS - Res Palliat Care. 2022;14:451-60.\u003c/li\u003e\n\u003cli\u003eGitige CG, Kweisigabo GP, Panga OD, Samizi FG, Abade AM, Mbelele PM, et al. Factors associated with Partners Elicitation during HIV Index client\u0026apos;s testing in Dar es Salaam Region, Tanzania. J Interv Epidemiol Public Health. 2021;4(3).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV/AIDS, index case testing, family-based testing, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-9321469/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9321469/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Family-based HIV index case testing identifies family members with unknown HIV status and links them to care. Data are limited in southern Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A facility-based cross-sectional study was conducted among 377 adults on antiretroviral therapy (ART) in Wolaita Zone, Southern Ethiopia, from November 2022 to May 2023. Participants were selected using systematic random sampling. Data were collected via interviewer-administered semi-structured questionnaire. Multivariable logistic regression identified factors associated with index case family testing. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated, and statistical significance was declared at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The proportion of index case family testing for HIV was 84.9% (95% CI: 81.2–88.6). In multivariable analysis, urban residence (AOR = 2.8; 95% CI: 1.16–6.75), duration on ART greater than 12 months (AOR = 13.0; 95% CI: 4.6–36.9), disclosure of HIV status to family members (AOR = 5.6; 95% CI: 1.9–16.5), discussion of HIV status with family members (AOR = 6.6; 95% CI: 1.9–23.2), and being counselled by health professionals to bring families for testing (AOR = 6.3; 95% CI: 2.1–19.0) were significantly associated with index case family testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The prevalence of family-based HIV index case testing in Wolaita Zone was 84.9% (95% CI: 81.2–88.6), which is below the national 95% target. Health professionals should strengthen counselling on ART adherence, status disclosure, family discussion, and active referral, as these factors were significantly associated with higher testing uptake among family members of people living with HIV.\u003c/p\u003e","manuscriptTitle":"Prevalence and Factors Associated with Family-Based HIV Index Case Testing in Wolaita Zone, Southern Ethiopia, 2023: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 12:38:42","doi":"10.21203/rs.3.rs-9321469/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4879d48-3a18-43a5-a013-95e769c2df86","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T12:38:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 12:38:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9321469","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9321469","identity":"rs-9321469","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}