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American Journal of  Medical 
Science and Innovation (AJMSI) 

HIV Testing Uptake: When Testers Are Not Tested – Implications for Reaching the First 95
Ogundipe Olubiyi Love1*, Ekundayo Olajumoke Kemi², Oludare Akinola Joseph3, Kajero Ayokunle1,

Guilavogui Jean Paul Yassa4

Volume 4 Issue 2, Year 2025
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v4i2.6082
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: September 01, 2025
Accepted: October 10, 2025
Published: November 04, 2025

Achieving the first UNAIDS 95-95-95 target requires optimizing provider-initiated HIV 
testing and counselling (PITC). Limited attention has been given to how HIV Testing 
Services (HTS) providers’ own testing practices influence their ability to convince clients 
to test. This study assessed HIV testing habits of  HIV Testing Services (HTS) providers in 
Ondo and Ekiti States, Nigeria, and their association with client uptake. A cross-sectional 
survey was conducted across 200 HTS centres, enrolling 786 active counsellors, testers, or 
dual-role providers. A structured questionnaire captured socio-demographic data, role, HIV 
knowledge score, and self-reported recency of  HIV testing. Provider activities were observed 
over three months to document client uptake rates. Descriptive statistics, chi-square tests, 
and multivariable logistic regression were applied. Only 23% of  providers had tested within 
the last 6 months; 11% had never tested. Testers were more likely to have tested recently 
(53%) compared to counsellors (8%). Counsellors who tested recently achieved higher client 
uptake (87%) than those who tested >12 months ago (42%) or never (12%). Independent 
predictors of  client uptake included tertiary education (OR=1.91; 95% CI: 1.44–2.54), 
being a tester/dual-role provider (OR=2.41; 95% CI: 1.58–3.69), higher knowledge score 
(OR=3.06; 95% CI: 2.07–4.52), and recent self-testing (OR=2.59; 95% CI: 1.70–3.95). Age 
was inversely associated (OR = 0.89 per year), and males had slightly higher odds (OR = 1.20). 
Provider-side factors, especially personal HIV testing behaviour, knowledge, education, and 
role, strongly influence client uptake. Normalizing regular provider self-testing, enhancing 
knowledge, and promoting multi-role competency may substantially improve HIV testing 
coverage, advancing progress toward Nigeria’s 95-95-95 targets.

Keywords
HIV Testing Services, HIV 
Multi-Role Competences, 
UNAIDS 95-95-95

1 Ondo State Primary Health Care Development Agency, Nigeria 
² Bamidele Olumilua University of  Education, Science and Technology, Nigeria 
³ Society for Family Health, Oyo State, Nigeria 
4 Public Health for All Institute, Conakry, Guinea
* Corresponding author’s e-mail: myloveinitiative@gmail.com

INTRODUCTION
HIV remains a major public health challenge globally, 
particularly in sub-Saharan Africa (Moyo et al., 2023). In 
Nigeria, around 1.9 million individuals were living with HIV 
as of  2020 (Bassey & Miteu, 2023), yet fewer than one-third 
know their status (McClarty et al., 2024). The UNAIDS 95-
95-95 targets require aggressive strategies to improve testing 
coverage (Frescura et al., 2022). However, for this goal 
ramping up HIV testing and understating barriers is required 
(Parikh et al., 2025; Ogunnusi et al., 2024).
Healthcare providers, especially HIV Testing Services 
(HTS) counsellors and testers, are central to these efforts. 
While a lot of  work has been done on various factors 
influencing service update for reproductive health 
services (Mshweshwe-Pakela et al., 2022; Mavodza et al., 
2021, Mannoh et al., 2022). However, limited attention 
has been given to providers’ own HIV testing practices 
and how these may affect their ability to encourage client 
testing. This study evaluates HIV testing uptake among 
HTS providers in Ekiti and Ondo States and examines its 
association with client uptake.

MATERIALS AND METHODS
Study Area
The study was conducted in Ondo and Ekiti States, 

southwest Nigeria. Recent studies documented HIV 
prevalence at 2.3% and 1.4% for Ondo and Ekiti States, 
respectively (Onazi et al., 2025). The states’ populations 
engaged in diverse economic activities, including 
agriculture, trade, and public service (Folorunso, 2020). 
The study sites included both urban and semi-urban 
facilities, covering a range of  primary and secondary 
healthcare centres as well as private facilities and civil 
society organizations that provide HIV testing and 
counselling services.

Sample Size Determination
The study targeted all active HTS providers within the 
selected 200 facilities. A total of  786 eligible participants 
(counsellors, testers, or those performing both roles) who 
had been actively engaged in HIV testing services for 
at least 12 months were enrolled. This census approach 
ensured comprehensive representation of  the HTS 
workforce across the two states.

Instrument Reliability
The reliability of  the questionnaire was assessed using 
the test-retest method. The instrument was administered 
twice to a group of  786 respondents from the HTS for the 
period of  the research. The responses from both rounds 



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Am. J. Med. Sci. Innov. 4(2) 98-102, 2025

were compared using the Pearson correlation coefficient, 
yielding a value of  0.85, indicating high consistency over 
time. This result confirmed the stability and reliability of  
the instrument for the research

Study Design and Population
A cross-sectional study design was employed. The study 
population comprised active HIV counsellors, testers, 
and dual-role providers working in the selected facilities. 
The sample included providers from varied settings to 
ensure diversity in socio-economic background, service 
delivery context, and client demographics.

Data Collection
A structured, pre-coded questionnaire using Google 
Form was developed to capture socio-demographic 
characteristics, professional role in HTS, HIV knowledge, 
and self-reported recency of  HIV testing. In addition, 
provider activities were observed over three months to 
record client HIV testing uptake rates attributable to each 
provider.

Data Analysis
Data were cleaned and analysed using descriptive statistics 
to summarize socio-demographic characteristics, HIV 
knowledge, provider roles, and testing habits. Chi-square 
tests were used to assess associations between provider 
characteristics and HIV testing behaviours. Multivariable 
logistic regression was employed to identify predictors 
of  client HIV testing uptake, with variables such as age, 
gender, education level, role, HIV knowledge score, and 
the provider’s own recent HIV testing history included in 
the model at 95% confidence intervals.

RESULTS AND DISCUSSION
Socio-Demographic Profile of  Providers
The study included 786 active HIV Testing Services 
(HTS) providers across 200 centres. The majority of  
respondents were aged 26-45, indicating that most 
providers were in the prime working age group. Females 
represented a higher proportion (59.3%) compared to 
males (40.7%), and a significant majority had at least 
secondary education (33.1%) or tertiary education 
(53.4%). Most providers (60%) held dual roles (both 
counselling and testing), which could influence their 
familiarity and proficiency with testing procedures, and 
this is represented in Table 1.

Testing Recency and Practice Patterns 
Testing Recency and practice patterns are figuratively 
summarized in Figures 1 and 2. Providers’ testing habits 
reveal critical insights: Only 23 % of  all providers 
reported testing themselves within the last 6 months, 
indicating a low rate of  recent self-testing among 
providers.  A notable 53% of  testers tested within the last 
6months, whereas only 8% of  counsellors tested within 
this period -highlighting a substantial disparity based on 
role.  Meanwhile, 42% of  counsellors last tested between 

6-12months ago, and an alarming 12% never tested 
at all. This suggested that a considerable proportion 
of  providers may not regularly engage in self-testing, 
potentially affecting their capacity to effectively promote 
testing among clients (Figure 3).

Impact of  Providers’ Testing Habits on Clients’ 
Testing Success
Providers who tested recently were significantly more 
effective at motivating clients to test. Providers who tested 
within 6months achieved an 87% client testing success 
rate. Conversely, Those who tested than 12months ago 
or never tested had considerably lower success rate-
42% and 12% respectively. This pattern underscores the 
importance of  provider self-testing in building credibility 
and trust with clients, thereby enhancing their motivation 
to get tested. 

Factors Influencing Clients Testing Outcomes
The regression result provide insight into the key 
determinants of  successful client testing uptake:

Age
Each additional year in the provider’s age slightly reduced 
the likelihood of  successfully convincing a client to test 
(OR=0.89). This may reflect younger providers employing 
more current, persuasive communication strategies or 
being more familiar with recent testing protocols.

Gender
Male providers had a marginally higher success rate 
(OR=1.20), possibly due to gender-related differences in 
communication styles or rapport-building

Level Education
Providers with tertiary education were almost twice as 
likely to succeed in persuading clients (OR=1.91). Higher 
education may confer better communication skills, 
enhanced health literacy, and confidence, all of  which are 
critical for effective counselling.

Role within HIV Testing Service
Those who performed both testing and counselling 
(or dual roles) had over twice the odds of  client testing 
success compared to counsellors alone (OR=2.41). Their 
procedural familiarity and direct testing capabilities 
potentially make them more persuasive.

HIV Knowledge Score
A higher HIV knowledge score was a strong predictor of  
success (OR=3.06). Technical competence and evidence-
based counselling seem to motivate more clients to 
proceed with testing.

Providers Own Recent HIV Testing (Self-Testing)
Providers who had tested recently were significantly 
more effective (OR=2.59). Their personal experience 
likely reduces stigma models positive health behavior, 



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and enhances credibility, all critical factors in encouraging 
clients to test. The proportion of  provider who tested 
within the last 6months was low, indicating a gap in 
personal engagement with HIV testing. There is a 

clear relationship between provider characteristics 
(education, role, knowledge, testing behavior) and client 
testing outcomes, emphasizing the need for targeted 
interventions.

Figure 1: HIV testing habit of  the HTS provider

Figure 2: Role based HTS recency among respondents

Table 1: Socio-demographic characteristics of  respondents (n=786)
Variable Frequency Percentage (%)
Age ≤25 120 15.3
26–35 250 31.8
36–45 220 28.0
46–55 130 16.5
56+ 66 8.4
Male 320 40.7
Female 466 59.3
No formal education 36 4.6
Primary 70 8.9
Secondary 260 33.1
Tertiary 420 53.4
Married 500 63.6
Single 210 26.7
Divorced/Separated 76 9.7
Counsellor 181 23.0
Tester 134 17.0
Both 471 60.0



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Table 2: HIV testing status of  personnel by categories and corresponding client success rate. 
Personnel Category Testing History Client Testing Rate (%)
Testers Test in last 6 months 98
Testers Test in last 12 months 92
Testers Never Tested 93
Counsellors Test in last 6 months 87
Counsellors Test in last 12 months 42
Counsellors Never Tested 12

Table 3: Logistic regression analysis of  predictors of  client success rate
Variable B S.E. Wald df Sig. Exp(B) 95% C.I. 

Lower
95% C.I. 
Upper

Age -0.120 0.050 5.760 1 0.017 0.890 0.805 0.984
Gender (Male=1) 0.180 0.080 5.060 1 0.025 1.200 1.023 1.406
Education (Tertiary) 0.650 0.150 18.780 1 <0.001 1.910 1.436 2.540
Role (Tester/Both vs Counsellor) 0.880 0.220 16.000 1 <0.001 2.410 1.576 3.688
Knowledge score 1.120 0.200 31.360 1 <0.001 3.060 2.072 4.518
Client uptake rate* 0.950 0.020 20.000 1 <0.001 2.590 1.700 3.947
Constant 0.658 0.713 0.853 1 0.356 1.931 - -

Figure 3: HIV Test recency-based client success rate among counsellors

Discussion
200 HTS centers in Ekiti and Ondo States, involving 786 
counsellors and testers active for at least 12 months. Only 
23% of  all respondents tested within the last 6 months, 
11% had never tested (Figure 1). Testers were more likely 
to have tested recently (53%) compared to counsellors 
(8%) (Figure 2). Counsellors who had tested recently 
achieved higher client uptake rates (87%) than those who 
had not (42%), and providers who never tested had the 
lowest client uptake (12%) (Figure 3). The multivariable 
regression analysis (Table 3) confirms that a combination 
of  socioeconomic status, provider characteristics, and 
behavioral practices significantly influences the likelihood 
of  successfully convincing a client to update their HIV test.
Providers with tertiary education had nearly double the 
odds of  client testing success (OR = 1.91; 95% CI: 1.44–
2.54) compared to those with lower education. Higher 

education may confer stronger communication skills, 
health literacy, and confidence in counselling, enhancing 
persuasive capacity. This aligns with global evidence 
that educational attainment in health workers correlates 
with improved health service delivery outcomes (Liu & 
Eggleton, 2022).
Role within the HIV testing service also emerged as a 
strong predictor. Testers and those combining roles were 
more than twice as likely to achieve uptake (OR = 2.41; 
95% CI: 1.58–3.69) compared to counsellors alone. This 
is consistent with findings from Kyilyosudu et al. (2023), 
which suggested that multi-role providers can leverage 
procedural familiarity and direct testing capability to 
improve uptake. Knowledge score was a powerful 
independent predictor (OR = 3.06; 95% CI: 2.07–4.52), 
underscoring the importance of  technical competence 
and evidence-based counselling in motivating clients. 



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The association supports prior literature showing that 
increased provider HIV knowledge enhances offer rates 
and acceptance of  testing.
Most notably, providers’ own HIV testing behavior was 
strongly associated with client success (OR = 2.59; 95% 
CI: 1.70–3.95). Providers who have tested recently may 
model positive health behavior, reduce stigma, and speak 
from experience, thereby increasing credibility and trust. 
Similar patterns were observed by Jamil et al (2021), 
where providers who used HIV self-testing themselves 
were significantly more likely to offer it to clients.
Age had a modest but significant negative association 
(OR = 0.89 per year), suggesting younger providers might 
employ more persuasive communication techniques or 
be more attuned to current testing protocols. Gender 
also showed a small effect (OR = 1.20), potentially 
reflecting cultural norms in provider-client interactions. 
From a program perspective, these findings suggest that 
interventions to improve client HIV testing uptake should 
include: (i) institutionalizing regular, confidential HIV 
testing for all providers; (ii) targeted capacity building 
for counsellors; (iii) fostering multi-role competency; 
and (iv) embedding provider role-modelling into training. 
These measures align with the UNAIDS 95-95-95 
target for 2030, which emphasizes expanding diagnosis 
through innovative strategies. This study identifies clear 
quantifiable predictors and the association between 
behavioral and structural determinants in successful HIV 
testing service updates. While self-report bias in provider 
testing history could be a limitation, further studies 
should explore the longitudinal effects of  provider testing 
interventions on client uptake.

CONCLUSION 
The identity of  the provider and their own actions matter 
greatly for clients’ HIV testing uptake. Normalizing 
provider self-testing, enhancing knowledge, and 
broadening role competencies can accelerate progress 
toward national and global HIV diagnosis targets. These 
results collectively suggest that improving providers’ 
own testing habits, enhancing their HIV knowledge, 
and fostering continuous professional development 
can significantly influence client testing behavior. 
Encouraging regular self-testing among providers may 
serve as a behavioral model for clients, reducing stigma 
and increasing the acceptability of  testing services.

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