Pa ge 1 Pa ge 98 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 Pa ge 99 https://journals.e-palli.com/home/index.php/ajmsi 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, Pa ge 10 0 https://journals.e-palli.com/home/index.php/ajmsi Am. J. Med. Sci. Innov. 4(2) 98-102, 2025 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 Pa ge 10 1 https://journals.e-palli.com/home/index.php/ajmsi Am. J. Med. Sci. Innov. 4(2) 98-102, 2025 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. Pa ge 10 2 https://journals.e-palli.com/home/index.php/ajmsi Am. J. Med. Sci. Innov. 4(2) 98-102, 2025 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. 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