Do people with disabilities have the same level of HIV knowledge and access to testing? Evidence from 513,252 people across 37 Multiple Indicator Cluster Surveys

Background Disability and HIV are intricately linked, as people with disabilities are at higher risk of contracting HIV and HIV can lead to impairments and disability. Despite this well-established relationship, there remains limited internationally comparable evidence on HIV knowledge and access to testing for people with disabilities. Methods and Findings We used cross-sectional data from 37 Multiple Indicator Cluster Surveys. 513,252 people were eligible for inclusion, including 24,695 (4.8%) people with disabilities. We examined risk ratios and their 95% confidence intervals for key indicators on HIV knowledge and access to testing for people with disabilities by sex and country. We also conducted a meta-analysis to get a pooled estimate for each sex and indicator. Men and women with disabilities were less likely to have comprehensive knowledge about HIV prevention (aRR: 0.74 [0.67, 0.81] and 0.75 [0.69, 0.83], respectively) and to know of a place to be tested for HIV (aRR: 0.95 [0.92, 0.99] and 0.94 [0.92, 0.97], respectively) compared to men and women without disabilities. Women with disabilities were also less likely to know how to prevent mother-to-child transmission (aRR: 0.87 [0.81, 0.93]) and ever have been tested for HIV (aRR: 0.90 [0.85, 0.94]), while men with disabilities showed some evidence of relative inequities for these indictors. There was also some evidence women with disabilities were less likely to be tested for HIV in the past year. Conclusion Men and women with disabilities face inequities in HIV knowledge and access to testing, particularly for women with disabilities. Governments must include people with disabilities in HIV programs by improving accessibility and increasing disability-inclusion in each health system building block. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office. SR is funded by the Rhodes Trust. HK is funded by an NIHR Global Research Professorship. Funders were not involved in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The London School of Hygiene and Tropical Medicine Research Ethics Committee approved this project on the 9th of November 2020 (reference number 22719). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data from UNICEF-supported MICS are publicly available. Our analysis code is also available online.