Temporal Dynamics of HIV Testing as a Predictor of Facility Delivery among adolescent girls and young women (AGYW): Evidence from the Zimbabwe Demographic and Health Surveys (2005–2015)

Background Facility-based delivery is critical for reducing maternal mortality. In high-HIV-prevalence settings such as Zimbabwe, integrating HIV testing and counselling (HTC) with antenatal care is central to PMTCT. However, the effect of HTC on maternal healthcare utilization remains underexplored. This study examines HIV testing as a determinant of facility delivery in Zimbabwe from 2005–2015. Methods Our study employed a pooled cross-sectional analysis of data from the Zimbabwe Demographic and Health Surveys (ZDHS) for 2005, 2010 and 2015. The study included women aged 15–24 whose last birth occurred within three years of each survey. The primary outcome was facility-based delivery, and the key exposure was self-reported and never tested for HIV. We used multivariable logistic regression, stratified by survey year, to analyse temporal trends and tested for a significant interaction between HIV testing and survey year. Results Among 4,018 women, 78.2% delivered in a health facility, increasing from 72.7% in 2005 to 86.8% in 2015. Women who had been tested for HIV were more likely to deliver in a facility (2005: aOR = 2.65, 95% CI: 1.64–4.26; 2010: aOR = 3.33, 95% CI: 2.07–5.36; 2015: aOR = 9.71, 95% CI: 3.50–26.90). Higher education (secondary or above: 2005: aOR = 1.38, 95% CI: 0.88–2.19; 2010: aOR = 2.19, 95% CI: 1.39–3.45; 2015: aOR = 3.30, 95% CI: 1.83–5.96) and attending ≥ 4 antenatal care visits (2005: aOR = 2.09, 95% CI: 1.26–3.49; 2010: aOR = 1.57, 95% CI: 1.05–2.34; 2015: aOR = 2.09, 95% CI: 1.14–3.83) also increased the likelihood of facility delivery. Rural residence was associated with lower delivery in 2005 (aOR = 0.11, 95% CI: 0.04–0.31) but not by 2015 (aOR = 1.47, 95% CI: 0.37–5.83). Conclusion Facility delivery in Zimbabwe has improved, driven by HIV testing, education, and antenatal care. Persistent inequalities remain through residence and service engagement. HIV testing is a key entry point, highlighting the impact of the PMTCT program. Efforts should focus on expanding HIV testing, strengthening ANC, and promoting education and women’s empowerment.