Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018
Emily Haeuser, Audrey L. Serfes, Michael A. Cork, Mingyou Yang, Hedayat Abbastabar, E S Abhilash, Maryam Adabi, Oladimeji Adebayo, Victor Adekanmbi, Daniel A Adeyinka, Saira Afzal, Bright Opoku Ahinkorah, Keivan Ahmadi, Muktar Beshir Ahmed, Yonas Akalu, Rufus Akinyemi, Chisom Joyqueenet Akunna, Fares Alahdab, Fahad Alanezi, Turki M Alanzi, Kefyalew Addis Alene, Robert Kaba Alhassan, Vahid Alipour, Amir Almasi‐Hashiani, Nelson Alvis‐Guzmán, Edward Kwabena Ameyaw, Saeed Amini, Dickson A Amugsi, Robert Ancuceanu, Davood Anvari, Seth Christopher Yaw Appiah, Jalal Arabloo, Olatunde Aremu, Mulusew Andualem Asemahagn, Mohammad Asghari Jafarabadi, Atalel Fentahun Awedew, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Yared Asmare Aynalem, Samad Azari, Zelalem Nigussie Azene, B. B. Darshan, Tesleem Kayode Babalola, Atif Amin Baig, Maciej Banach, Till Bärnighausen, Arielle Wilder Bell, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Ali Bijani, Zebenay Workneh Bitew, Somayeh Bohlouli, Obasanjo Afolabi Bolarinwa, Archith Boloor, Ivana Božičević, Zahid A Butt, Rosario Cárdenas, Félix Carvalho, Jaykaran Charan, Vijay Kumar Chattu, Mohiuddin Ahsanul Kabir Chowdhury, Dinh‐Toi Chu, Richard G. Cowden, Saad M A Dahlawi, Giovanni Damiani, Eugene Kofuor Maafo Darteh, Aso Mohammad Darwesh, José das Neves, Nicole Davis Weaver, Diego De Leo, Jan‐Walter De Neve, Kebede Deribe, Keshab Deuba, Samath Dhamminda Dharmaratne, Mostafa Dianatinasab, Daniel Díaz, Alireza Didarloo, Shirin Djalalinia, Fariba Dorostkar, Eleonora Dubljanin, Bereket Duko, Maha El Tantawi, Shaimaa I El-Jaafary, Babak Eshrati, Sharareh Eskandarieh, Oghenowede Eyawo, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Farshad Farzadfar, Nazir Fattahi, Nelsensius Klau Fauk, Eduarda Fernandes, Irina Filip, Florian Fischer, Nataliya A Foigt, Masoud Foroutan, Takeshi Fukumoto, Mohamed M. Gad
Abstract
BACKGROUND: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA. METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.