RQ1: What is the association between sociodemographic factors (gender, place of residence, level of education, geopolitical zone, and SES) and HCT uptake among young people in Nigeria?

H₀₁: Sociodemographic factors will not be significantly associated with HCT uptake among young people in Nigeria.

H_a1: Sociodemographic factors will be significantly associated with HCT uptake among young people in Nigeria.

This study is a quantitative research. Quantitative research is deductive and confirmatory [16] . The design used in the study was a non-experimental, cross-sectional research design. This design was adopted because the data were collected only once in 2013. Again, the use of secondary data made a cross-sectional design the most appropriate for this study.

The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. This age group was considered because according to the NARHS Plus individuals aged 15 to 24 years are considered young adults [14] . The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprises all 36 states in Nigeria [14] . Probability sampling technique was used to obtain a sample of 10091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Stage 1 involved the selection of rural and urban zones. Stage 2 involved the selection of enumeration areas within the selected rural and urban zones. The listing and selection of households were conducted in Stage 3, and Stage 4 involved the selection of young respondents to complete the survey and participate in HIV testing. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192; urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Out of the households, a total of 31,235 individual respondents were interviewed using the NARHS Plus [14] . Among the individual respondents, 15,596 were men, and 15,639 were women, resulting in a response rate of 88%. The data set was released in December 2013 by the FMOH, but it is not yet available to the public. Secondary data were collected from 31,235 respondents who were interviewed using the NARHS Plus [14] . To obtain the required sample size, which comprised young people in Nigeria ages 15 to 24 years, data were filtered to include only individuals in that age range (10,091 individuals).

Data were analyzed by inputting them into SPSS v21.0 for analysis and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages; measures of central tendencies such as the mean, standard deviation, and range were used to answer the research question. Nonparametric test such as chi-square was used to analyze non-normally distributed data.

SES was computed as a construct of the responses to three questions: type of dwelling structure, items currently possessed in household, and number of meals a day throughout an average month. The highest score for SES was 10, which was converted into a categorical variable (0 - 2: poorest, 3 - 4: poorer, 5 - 6: middle, 7 - 8: richer, 9 - 10: richest). The researcher assigned scores according to the responses of the participants. For type of dwelling structure, a score of 1 was assigned to participants who lived in mud house with thatched roof, mud house with zinc roof, and wood and makeshift structures. A score of 2 was assigned to participants who lived in mini-flats, room and parlor, or single rooms. A score of 3 was assigned to participants who lived in single- family house, duplexes, and two- or three-bedroom apartments.

For the items currently possessed in the households, participants were asked whether they owned a total of 22 items, one of which was excluded (owns boat/ship/canoe) because of the vagueness of the statement. A score of 1 was assigned to participants who owned no more than seven items; a score of 2 was assigned to participants who owned more than seven, but not more than 14, items; and a score of 3 was assigned to participants who owned more than 14 items. For the number of meals per day throughout an average month, scores were assigned according to the responses: 1: cannot guarantee one meal a day throughout the month, 2: only afford one meal a day throughout the month, 3: only afford two meals a day throughout the month, and 4: afford three meals a day throughout the month. The highest possible score for SES was 10 (i.e., the sum of the total correct scores), and the lowest was 0.

Sociodemographic factors comprised five variables: gender, place of residence, level of education, geopolitical zone, and SES. Table 1 presents the frequency table for gender, with the sample comprising 4075 (45.7%) male participants and 4845 (54.3%) female participants.

Place of residence was categorized as living in urban or rural areas. A total of 2841 (31.8%) participants lived in urban areas, and 6079 (68.2%) participants lived in rural areas of Nigeria (see Table 2).

Level of education was categorized as no formal education, Qur’anic only, primary, secondary, or higher. Eight (0.1%) participants failed or chose not to respond to education level and these responses were treated as missing responses. For the sample, 1180 (13.2%) participants had no formal education, 500 (5.6%) had Qur’anic only, 936 (10.5%) had primary schooling as their highest level of education, 5572 (62.5%) had secondary education as their highest level, and 724 (8.1%) had higher education (see Table 3).

Geopolitical zone of Nigeria was categorized as northcentral, northeast, northwest, southeast, south south, and southwest. The participants were somewhat evenly distributed across the six geopolitical zones, with 1641 (18.4%) from the northcentral zone, 1345 (15.1%) from the northeast zone, 1534 (17.2%) from the northwest zone, 1443 (16.2%) from the southeast zone, 1631 (18.3%) from the south south zone, and 1326 (14.9%) from the southwest zone (see Table 4).

SES was categorized as poorest, poorer, middle, richer, and richest. As observed, 20 (0.2%) participants belonged to the poorest category, 353 (4%) belonged to the poorer category, 2765 (31%) belonged to the middle category, 4337 (48.6%) belonged to the richer category, and 1444 (16.2%) belonged to the richest category (see Table 5). There was one observation that had a missing response on SES.

The hypothesis examined whether five sociodemographic factors (gender, place of residence, level of education, geopolitical zone, and SES) were significantly associated with the uptake of HCT among young people in Nigeria.

To examine the association between geopolitical zone and HCT uptake, I conducted a chi-square test between the two variables. Table 6 presents the cross-tabulation table for geopolitical zone and HCT uptake. The participants from the northcentral zone were the most likely to have HCT uptake, followed respectively by participants from the southeast zone, southwest zone, northeast zone, and northwest zone.

Results of the multivariate binomial logistic regression, testing for all IVs as predictors of HCT uptake indicated that the variables of gender, place of residence, education, geopolitical zone, knowledge of where to obtain HCT, and knowledge of HIV transmission were statistically significant predictors of the likelihood of having HCT uptake. Table 7 represents the chi-square test for geopolitical zone and HCT uptake.

The results of the chi-square test of association between geopolitical zone and HCT uptake showed that there is a statistically significant relationship between geopolitical zone and HCT uptake among young people ages 15 to 24 years in Nigeria, X² (5, N = 8920) = 186.40, p < 0.001.

The demographic variables of gender, place of residence, level of education, geopolitical zone, and SES were found to be significantly associated with HCT uptake in the sample. A discussion of each demographic factor follows.

Gender. The study found that the female participants had a small but significantly higher incidence of HCT uptake than the male participants did. Potential reasons are that HIV generally has longer lasting and more severe effects on women than on men and because women are more conscious and aware of their sexual health status [2] . Women have a higher knowledge of where to obtain HCT services and were more likely to use HCT services than men [17] . However, HIV is equally serious and equally deadly for men and women. The implication

of this result to my study is that although there is a significant need for HCT uptake by both genders, the need is even greater for men.

Place of Residence. Place of residence, that is, urban versus rural, was associated with the participants’ HCT uptake, with the incidence of HCT uptake being lower for participants from rural areas. This result might reflect the relative lack of HCT facilities in rural settings or the cognitive differences (discussed in the next section) between urban and rural populations. Various researchers have confirmed greater use of HCT facilities when individuals live in close proximity to such facilities, as they generally would in urban settings [1] [18] - [20] .

Level of Education. The study found level of education to be positively associated with HCT uptake; the higher the level of education, the greater was the use of HCT resources. This result supports earlier findings that a constant and linear relationship exists between level of education and HCT uptake [6] [21] [22] .

Geopolitical Zone. It was found that although geopolitical zone did have a significant relationship with HCT uptake, no pattern emerged other than the urban versus rural difference. Although differences existed in the different geographical areas of Nigeria in terms of HCT uptake rates, they did not suggest any particular actions or interventions. It could be, as suggested earlier, that proximity to HCT facilities is the most important factor in HCT uptake.

SES. The study found that SES had a significant relationship with HCT uptake. Participants with a higher SES had higher HCT uptake rates. Several researchers identified a positive correlation between university attendance and HCT uptake [18] [23] [24] . Because university students in Nigeria tend to be more affluent than other urban dwellers, or come from families that are, and urban dwellers tend to be more affluent than rural residents, this fact reinforces other findings of the study.