Abstract
Abstract Background The Tigray region of Ethiopia has been affected by a prolonged conflict that significantly disrupted public health services and led to widespread population displacement. While these events raised important concerns about their potential impact on HIV transmission, current evidence remains limited regarding HIV prevalence, transmission dynamics, and associated risk factors in the post-conflict period. This study assessed HIV prevalence, recent infection, and associated factors among adults in Ethiopia’s Tigray Region. Methods A community-based cross-sectional study was conducted among 6,425 participants selected using multistage random sampling across 30 districts from June to September 2024. A trained team of health professionals collected socio-demographic data using interviewer-administered structured questionnaires deployed on Open Data Kit (ODK). We obtained blood samples for HIV testing following the national testing algorithm. We used descriptive statistics to describe participant characteristics and multivariable logistic regression to identify factors associated with HIV seropositivity. Results Of the 6,425 individuals approached, 6,010 participated (93.5%). The overall HIV prevalence was 3% [95% CI: 2.6 to 3.5]. Among individuals who tested positive for HIV, the recency test classified 74.4% as having long-term infections and 25.6% as having recent infections. Multivariable logistic regression revealed a number of factors associated with HIV infection. HIV infection was significantly associated with female sex (AOR = 2.1; 95% CI: 1.29–3.36), divorced (AOR = 2.9; 95% CI: 1.22–6.93) or widowed marital status (AOR = 3.9; 95% CI: 1.40–10.92), and urban residence (AOR = 1.9; 95% CI: 1.27–2.94). Conclusions The study demonstrates a post-war HIV prevalence of 3% in Tigray - three times the epidemic threshold - with a substantial proportion of recent infections, indicating ongoing transmission. Women, urban residents, and those divorced or widowed were disproportionately affected. These findings underscore the urgent need for conflict-sensitive HIV prevention strategies, expanded community-based and mobile testing with rapid linkage to treatment, and health system restoration in order to address the humanitarian crisis and stop it from getting worse.