@article{fdi:010086046, title = {{U}nderstanding the pathways leading to socioeconomic inequalities in {HIV} testing uptake in 18 sub-{S}aharan {A}frican countries}, author = {{A}nte-{T}estard, {P}. {A}. and {H}amidouche, {M}. and {A}pouey, {B}. and {B}aggaley, {R}. and {L}armarange, {J}oseph and {B}enmarhnia, {T}. and {T}emime, {L}. and {J}ean, {K}.}, editor = {}, language = {{ENG}}, abstract = {{O}bjective: {T}o better understand the different pathways linking socioeconomic position and {HIV} testing uptake in 18 sub-{S}aharan {A}frican countries. {D}esign: {W}e used cross-sectional population-based surveys between 2010 and 2018. {M}ethods: {U}sing a potential outcomes framework and the product method, we decomposed the total effect linking wealth and recent (<12 months) {HIV} testing into direct effects, and indirect effects, via internal (related to individual's ability to perceive need for and to seek care) or external (ability to reach, pay for and engage in healthcare) mediators to calculate the proportion mediated ({PM}) by each mediator. {R}esults: {H}igh levels of inequalities were observed in nine and 15 countries among women and men, respectively. {T}he mediator indirect effect varied greatly across countries. {T}he {PM} tended to be higher for internal than for external mediators. {F}or instance, among women, {HIV}-related knowledge was estimated to mediate up to 12.1% of inequalities in {C}ote d'{I}voire; and up to 31.5% for positive attitudes towards people with {HIV} ({PWH}) in {S}enegal. {F}or the four external mediators, the {PM} was systematically below 7%. {S}imilar findings were found when repeating analyses on men for the internal mediators, with higher {PM} by attitudes towards {PWH} (up to 39.9% in {S}enegal). {C}onclusions: {O}ur findings suggest that wealth-related inequalities in {HIV} testing may be mediated by internal more than external characteristics, with important variability across countries. {O}verall, the important heterogeneities in the pathways of wealth-related inequalities in {HIV} testing illustrate that addressing inequalities requires tailored efforts and upstream interventions.}, keywords = {health inequalities ; {HIV} ; {HIV} testing ; mediation analysis ; socioeconomic ; inequalities ; sub-{S}aharan {A}frica ; {AFRIQUE} {SUBSAHARIENNE}}, booktitle = {}, journal = {{AIDS}}, volume = {36}, numero = {12}, pages = {1707--1716}, ISSN = {0269-9370}, year = {2022}, DOI = {10.1097/qad.0000000000003316}, URL = {https://www.documentation.ird.fr/hor/fdi:010086046}, }