Beyond Individual Knowledge: How Psychosocial and Community Determinants Predict HIV Self-Screening Uptake. A Multilevel Evidence from Sunyani, Ghana

Background: HIV self-screening has emerged as a promising strategy to enhance early diagnosis and expand testing coverage, particularly in Sub-Saharan Africa. Despite increased availability, uptake remains suboptimal, suggesting the influence of underlying psychosocial and community-level factors. Objective: This study examined the psychosocial and community determinants of HIV self-screening uptake, with a focus on the relative influence of individual perceptions, fear, and community attitudes. Methods: A quantitative cross-sectional design was employed using data from 385 respondents. Descriptive statistics and binary logistic regression analyses were conducted to assess the association between psychosocial factors, community-level variables, and HIV self-screening uptake. Two regression models were estimated to distinguish between individual-level and combined individual–community effects. Results: The findings revealed that fear and negative perceptions toward HIV self-testing were significant predictors of reduced uptake. Individuals with negative perceptions were substantially less likely to engage in self-screening. Community-level stigma toward people living with HIV also showed a significant negative association with testing behavior, while other community variables were not statistically significant. Additionally, a notable gap was observed between access to testing and actual uptake, indicating that availability alone does not ensure utilization. Conclusion: The study highlights the dominant role of psychosocial barriers over structural access in influencing HIV self-screening uptake. Effective interventions should integrate behavioral, psychological, and community-based strategies to address fear, improve perceptions, and reduce stigma. These findings provide important insights for designing context-sensitive public health interventions aimed at increasing HIV testing uptake.