Low coverage of HIV testing among adolescents and young adults in Nigeria: Implication for achieving the UNAIDS first 95

BACKGROUND: Most studies on HIV testing among young people in Nigeria are not nationally representative. As such, recent nationally representative data, such as the Multiple Indicator Cluster Survey (MICS), could help assess the current level of HIV testing among young people, a key target population for HIV prevention in the country. In this study, we examined the coverage and factors associated with HIV testing among adolescents and young adults (AYA). METHODS: We used the data for 14,312 AYA that examined recent and lifetime HIV testing from the 2017 MCIS. Our outcomes of interest were ever tested for HIV and recently tested for HIV. We examined the association between socio-demographic factors (e.g., age, marital status, education attainment, wealth status), stigma belief, exposure to media and HIV knowledge, and uptake of HIV testing using adjusted and unadjusted logistic regression models. RESULTS: Less than a quarter of the AYA (23.7%) had ever tested for HIV, and an even lower proportion (12.4%) tested in the year preceding the survey. More females (25.4%) compared to males (20.8%) had ever tested for HIV. Young people who were aged 20–24 years (AOR 1.52, 95% CI 1.34–1.72), married (AOR 2.42, 95% CI 1.98–2.97), had higher educational attainment (AOR 5.85, 95% CI 4.39–7.81), and belonged to the wealthiest quintile (AOR 1.99, 95% CI 1.53–2.60), had higher odds of having ever tested for HIV compared to those aged 15–19 years, never married, had no formal education and belonged to the poorest wealth quintile. Also, those who had positive stigma belief towards people living with HIV (AOR 2.93, 95% CI 2.47–3.49), had higher HIV knowledge (AOR 1.62, 95% CI 1.24–2.11), and higher media exposure (AOR 1.64, 95% CI 1.36–1.97), had higher odds of having ever tested compared to those who had more negative stigma belief, had low knowledge of HIV and low media exposure. CONCLUSION: The HIV testing coverage among AYA in Nigeria is well below the national target of 95% indicated in the national HIV/AIDS strategic framework (2017–2021). Also, the low rate of HIV testing found in this study means realising the UNAIDS first 95 will require interventions targeting AYA. These interventions should focus on improving young people's knowledge of HIV, reducing negative stigma belief through media campaigns and increasing access to HIV testing through home-based testing and "opt-out" strategy at the point of care.