Factors Associated with Sexually Transmitted Infection Screening Outcomes Among Young People in Selected Districts of Zimbabwe

Abstract

Sexually transmitted infections (STIs) are a significant public health burden among young people in the age group of 15-24 years in Zimbabwe. This is backed by literature which reports high prevalence across the globe, with the bulk of them being asymptomatic. Regardless of the existence of digital health innovations for example, the OPHID-owned digital job aide and the District Health Information System 2 (DHIS2) routine data that is captured, these data sources are somewhat underutilized in explaining and linking geographic patterns of STI screening outcomes among young people across districts in Zimbabwe. This study aimed to examine STI geographic variation and the factors associated with its screening among young people in selected districts of Zimbabwe between the years 2023 and 2025. An analysis of district variations, monthly trends, demographic and service-related factors together with existing associations between digital job aide screening volumes and DHIS2 reported cases. A secondary cross-sectional analytical design was employed, with data being analysed from the Boost digital job aide application (n = 189,863 STI screening records) and disaggregated district-level data from DHIS2, covering eight districts. Descriptive statistics, chi-square tests, and multivariable logistic and Poisson regression analyses were conducted using Stata version 18 on a data set of 189,863 adolescents screened through the Boost app. Geographic heterogeneity was observed, with Chitungwiza and Gwanda recording the highest burdens, while Mangwe and Beitbridge reported the lowest rates. DHIS2 data revealed a modest, non-statistically significant increase in total STI burden between 2023 and 2024 (IRR = 1.06; p = 0.383), with urethral and vaginal discharge accounting for over 60% of cases across all districts. Multivariable analysis identified female sex, older age (20-24 years), urban residence, and attendance to hub facilities as significantly associated with positive STI screening outcomes. Urban residents had approximately 9.5 times greater odds of a positive outcome compared to rural residents (aOR = 9.53; 95% CI: 8.89–10.23), while hub facility attendees had 20 times greater odds compared to primary health care attendees (aOR = 20.19; 95% CI: 18.02–22.62). STI burden among young people in Zimbabwe is geographically heterogeneous and is influenced by demographic, behavioral, and service related factors. The study findings underscore a need for targeted, district-specific interventions, strengthening sexual and reproductive health programmes and expanding youth-friendly services, with a particular focus on young women and older adolescents aged 20-24 years.