Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018.
Haeuser E., Serfes AL., Cork MA., Yang M., Abbastabar H., Abhilash ES., Adabi M., Adebayo OM., Adekanmbi V., Adeyinka DA., Afzal S., Ahinkorah BO., Ahmadi K., Ahmed MB., Akalu Y., Akinyemi RO., Akunna CJ., Alahdab F., Alanezi FM., Alanzi TM., Alene KA., Alhassan RK., Alipour V., Almasi-Hashiani A., Alvis-Guzman N., Ameyaw EK., Amini S., Amugsi DA., Ancuceanu R., Anvari D., Appiah SCY., Arabloo J., Aremu O., Asemahagn MA., Jafarabadi MA., Awedew AF., Quintanilla BPA., Ayanore MA., Aynalem YA., Azari S., Azene ZN., Darshan BB., Babalola TK., Baig AA., Banach M., Bärnighausen TW., Bell AW., Bhagavathula AS., Bhardwaj N., Bhardwaj P., Bhattacharyya K., Bijani A., Bitew ZW., Bohlouli S., Bolarinwa OA., Boloor A., Bozicevic I., Butt ZA., Cárdenas R., Carvalho F., Charan J., Chattu VK., Chowdhury MAK., Chu D-T., Cowden RG., Dahlawi SMA., Damiani G., Darteh EKM., Darwesh AM., das Neves J., Weaver ND., De Leo D., De Neve J-W., Deribe K., Deuba K., Dharmaratne S., Dianatinasab M., Diaz D., Didarloo A., Djalalinia S., Dorostkar F., Dubljanin E., Duko B., El Tantawi M., El-Jaafary SI., Eshrati B., Eskandarieh S., Eyawo O., Ezeonwumelu IJ., Ezzikouri S., Farzadfar F., Fattahi N., Fauk NK., Fernandes E., Filip I., Fischer F., Foigt NA., Foroutan M., Fukumoto T., Gad MM., Gaidhane AM., Gebregiorgis BG., Gebremedhin KB., Getacher L., Ghadiri K., Ghashghaee A., Golechha M., Gubari MIM., Gugnani HC., Guimarães RA., Haider MR., Haj-Mirzaian A., Hamidi S., Hashi A., Hassanipour S., Hassankhani H., Hayat K., Herteliu C., Ho HC., Holla R., Hosseini M., Hosseinzadeh M., Hwang B-F., Ibitoye SE., Ilesanmi OS., Ilic IM., Ilic MD., Islam RM., Iwu CCD., Jakovljevic M., Jha RP., Ji JS., Johnson KB., Joseph N., Joshua V., Joukar F., Jozwiak JJ., Kalankesh LR., Kalhor R., Kamyari N., Kanchan T., Matin BK., Karimi SE., Kayode GA., Karyani AK., Keramati M., Khan EA., Khan G., Khan MN., Khatab K., Khubchandani J., Kim YJ., Kisa A., Kisa S., Kopec JA., Kosen S., Laxminarayana SLK., Koyanagi A., Krishan K., Defo BK., Kugbey N., Kulkarni V., Kumar M., Kumar N., Kusuma D., La Vecchia C., Lal DK., Landires I., Larson HJ., Lasrado S., Lee PH., Li S., Liu X., Maleki A., Malik P., Mansournia MA., Martins-Melo FR., Mendoza W., Menezes RG., Mengesha EW., Meretoja TJ., Mestrovic T., Mirica A., Moazen B., Mohamad O., Mohammad Y., Mohammadian-Hafshejani A., Mohammadpourhodki R., Mohammed S., Mohammed S., Mokdad AH., Moradi M., Moraga P., Mubarik S., Mulu GBB., Mwanri L., Nagarajan AJ., Naimzada MD., Naveed M., Nazari J., Ndejjo R., Negoi I., Ngalesoni FN., Nguefack-Tsague G., Ngunjiri JW., Nguyen CT., Nguyen HLT., Nnaji CA., Noubiap JJ., Nuñez-Samudio V., Nwatah VE., Oancea B., Odukoya OO., Olagunju AT., Olakunde BO., Olusanya BO., Olusanya JO., Bali AO., Onwujekwe OE., Orisakwe OE., Otstavnov N., Otstavnov SS., Owolabi MO., Mahesh PA., Padubidri JR., Pana A., Pandey A., Pandi-Perumal SR., Kan FP., Patton GC., Pawar S., Peprah EK., Postma MJ., Preotescu L., Syed ZQ., Rabiee N., Radfar A., Rafiei A., Rahim F., Rahimi-Movaghar V., Rahmani AM., Ramezanzadeh K., Rana J., Ranabhat CL., Rao SJ., Rawaf DL., Rawaf S., Rawassizadeh R., Regassa LD., Rezaei N., Rezapour A., Riaz MA., Ribeiro AI., Ross JM., Rubagotti E., Rumisha SF., Rwegerera GM., Moghaddam SS., Sagar R., Sahiledengle B., Sahu M., Salem MR., Kafil HS., Samy AM., Sartorius B., Sathian B., Seidu A-A., Shaheen AA., Shaikh MA., Shamsizadeh M., Shiferaw WS., Shin JI., Shrestha R., Singh JA., Skryabin VY., Skryabina AA., Soltani S., Sufiyan MB., Tabuchi T., Tadesse EG., Taveira N., Tesfay FH., Thapar R., Tovani-Palone MR., Tsegaye GW., Umeokonkwo CD., Unnikrishnan B., Villafañe JH., Violante FS., Vo B., Vu GT., Wado YD., Waheed Y., Wamai RG., Wang Y., Ward P., Wickramasinghe ND., Wilson K., Yaya S., Yip P., Yonemoto N., Yu C., Zastrozhin MS., Zhang Y., Zhang Z-J., Hay SI., Dwyer-Lindgren L., Local Burden of Disease sub-Saharan Africa HIV Prevalence Collaborators None.
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.