Factors associated with unawareness of HIV-positive status among individuals aged ≥ 15 years in Tanzania: Evidence from the Tanzania HIV Impact Survey 2022–2023

Abstract Introduction In Tanzania, despite the progress in HIV testing and counseling, 39.4% of people living with HIV aged ≥ 15 years were unaware of their HIV status in 2017. HIV testing is a crucial entry point for prevention, early diagnosis, and treatment of HIV to increase survival, improve quality of life, and prevent further transmission. This analysis aimed to estimate the proportion of individuals aged ≥ 15 years living with HIV in Tanzania who were unaware of their HIV status and to determine factors associated with unawareness of HIV-positive status. Methods We analyzed data from the Tanzania HIV Impact Survey 2022–2023, a nationally representative cross-sectional survey which employed a two-stage cluster sampling design and included HIV testing at the household with laboratory confirmation. This analysis focused on individuals aged ≥ 15 years who tested HIV-positive during the survey. Weighted percentages were calculated to summarize demographic information and the proportion unaware of their HIV-positive status. Logistic regression accounting for complex survey design was used to determine factors associated with unawareness of HIV-positive status. Results A total of 1,850 individuals aged ≥ 15 years tested HIV positive, among which 266 (17.3%) were unaware of their HIV-positive status. Males were more likely to be unaware of their HIV-positive status than females (21.6%, aOR = 1.67, 95% CI: 1.06–2.61, p = 0.029 vs. 15.2%). Young people aged 15 − 24 years were over five times more likely to be unaware of their HIV-positive status (aOR = 5.61, 95% CI: 2.12–14.84, p = 0.001) compared to individuals aged ≥ 55 years. Individuals who reported not using a condom at last sexual intercourse in the past year were more likely to be unaware of their HIV status than those who reported condom use (aOR = 2.36, 95% CI: 1.32–4.20, p = 0.005). Those with at least one partner living with HIV were less likely to be unaware of their HIV-positive status compared to individuals with all sexual partners who were HIV negative (aOR = 0.04, 95% CI: 0.00-0.42, p = 0.009). Conclusion Despite robust HIV case-finding interventions in Tanzania, 1 in 6 PLHIV were unaware of their HIV-positive status. Targeted HIV case-finding interventions should continue with a focus on reaching men and young people who were more likely to be unaware of their status. HIV prevention strategies, such as condom use, remain crucial, since individual behaviors were linked to awareness of HIV status.