# Drivers of Utilization of HIV Self‐Test Among Males in Malawi: A Multilevel Analysis of the Multiple Indicator Cluster Survey 2019‐2020

## TL;DR

This study explores factors influencing HIV self-testing among men in Malawi using survey data, finding that internet use and region are significant predictors.

## Contribution

The study provides new insights into male-specific predictors of HIV self-testing utilization in Malawi using multilevel analysis.

## Key findings

- Approximately 10% of males aged 15–49 in Malawi have ever used an HIV self-test.
- Internet use and prior HIV testing history are significant predictors of HIV self-testing utilization.
- Rural residence and region are strongly associated with lower odds of HIV self-testing.

## Abstract

Implementation of health programs often overlooks males compared to females, and this is true even for HIV programs. Most men do not visit hospitals, and this is where, for example, most of the HIV services are delivered, including HIV testing. Self‐testing can help men know their HIV status and possibly prevent the spread and increase treatment uptake.

This study aimed to assess the utilization of HIV self‐testing among males in Malawi and its predictors.

This paper utilizes secondary quantitative data from the 2019‐2020 Multiple Indicator Cluster Survey (MICS). The study sample included 7750 males aged 15 to 49. Data analysis used the Chi‐square test to show the association between self‐testing and rural/urban residence, region, radio‐listenership, internet use, prior testing history, and educational level. Then, a multilevel binary logistic regression analysis was done to show the effect of predictor variables on the outcome reporting on the fixed and random effects, including the odds ratio, 95% confidence interval, and intraclass correlation coefficient. Statistical significance was determined at the p < 0.05 level.

Approximately 10% of males have ever used an HIV self‐test. The logistic regression model indicated that ever used the internet (OR = 1.535, CI: [1.231, 1.9150], p < 0.05), ever tested for HIV (OR = 0.181, CI: [0.122, 0.268], p < 0.001), rural residence (OR = 0.493, CI: [0.349, 0.698], p < 0.001), and region (OR = 3.619, CI: [2.120, 6.178], p < 0.001).

The study confirms that HIVST is affected by several sociodemographic factors, calling for targeted interventions to improve HIVST among males.