Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000–2018
Authors: Haeuser Emily , Serfes Audrey L. , Cork Michael A. , Yang Mingyou , Abbastabar Hedayat , Abhilash E. S. , Adabi Maryam , Adebayo Oladimeji M. , Adekanmbi Victor , Adeyinka Daniel Adedayo , Afzal Saira , Ahinkorah Bright Opoku , Ahmadi Keivan , Ahmed Muktar Beshir , Akalu Yonas , Akinyemi Rufus Olusola , Akunna Chisom Joyqueenet , Alahdab Fares , Alanezi Fahad Mashhour , Alanzi Turki M. , Alene Kefyalew Addis , Alhassan Robert Kaba , Alipour Vahid , Almasi-Hashiani Amir , Alvis-Guzman Nelson , Ameyaw Edward Kwabena , Amini Saeed , Amugsi Dickson A. , Ancuceanu Robert , Anvari Davood , Appiah Seth Christopher Yaw , Arabloo Jalal , Aremu Olatunde , Asemahagn Mulusew A. , Jafarabadi Mohammad Asghari , Awedew Atalel Fentahun , Quintanilla Beatriz Paulina Ayala , Ayanore Martin Amogre , Aynalem Yared Asmare , Azari Samad , Azene Zelalem Nigussie , Darshan B. B. , Babalola Tesleem Kayode , Baig Atif Amin , Banach Maciej , Bärnighausen Till Winfried , Bell Arielle Wilder , Bhagavathula Akshaya Srikanth , Bhardwaj Nikha , Bhardwaj Pankaj , Bhattacharyya Krittika , Bijani Ali , Bitew Zebenay Workneh , Bohlouli Somayeh , Bolarinwa Obasanjo Afolabi , Boloor Archith , Bozicevic Ivana , Butt Zahid A. , Cárdenas Rosario , Carvalho Felix , Charan Jaykaran , Chattu Vijay Kumar , Chowdhury Mohiuddin Ahsanul Kabir , Chu Dinh-Toi , Cowden Richard G. , Dahlawi Saad M. A. , Damiani Giovanni , Darteh Eugene Kofuor Maafo , Darwesh Aso Mohammad , das Neves José , Weaver Nicole Davis , De Leo Diego , De Neve Jan-Walter , Deribe Kebede , Deuba Keshab , Dharmaratne Samath , Dianatinasab Mostafa , Diaz Daniel , Didarloo Alireza , Djalalinia Shirin , Dorostkar Fariba , Dubljanin Eleonora , Duko Bereket , El Tantawi Maha , El-Jaafary Shaimaa I. , Eshrati Babak , Eskandarieh Sharareh , Eyawo Oghenowede , Ezeonwumelu Ifeanyi Jude , Ezzikouri Sayeh , Farzadfar Farshad , Fattahi Nazir , Fauk Nelsensius Klau , Fernandes Eduarda , Filip Irina , Fischer Florian , Foigt Nataliya A. , Foroutan Masoud , Fukumoto Takeshi , Gad Mohamed M. , Gaidhane Abhay Motiramji , Gebregiorgis Birhan Gebresillassie , Gebremedhin Ketema Bizuwork , Getacher Lemma , Ghadiri Keyghobad , Ghashghaee Ahmad , Golechha Mahaveer , Gubari Mohammed Ibrahim Mohialdeen , Gugnani Harish Chander , Guimarães Rafael Alves , Haider Mohammad Rifat , Haj-Mirzaian Arvin , Hamidi Samer , Hashi Abdiwahab , Hassanipour Soheil , Hassankhani Hadi , Hayat Khezar , Herteliu Claudiu , Ho Hung Chak , Holla Ramesh , Hosseini Mostafa , Hosseinzadeh Mehdi , Hwang Bing-Fang , Ibitoye Segun Emmanuel , Ilesanmi Olayinka Stephen , Ilic Irena M. , Ilic Milena D. , Islam Rakibul M. , Iwu Chidozie C. D. , Jakovljevic Mihajlo , Jha Ravi Prakash , Ji John S. , Johnson Kimberly B. , Joseph Nitin , Joshua Vasna , Joukar Farahnaz , Jozwiak Jacek Jerzy , Kalankesh Leila R. , Kalhor Rohollah , Kamyari Naser , Kanchan Tanuj , Matin Behzad Karami , Karimi Salah Eddin , Kayode Gbenga A. , Karyani Ali Kazemi , Keramati Maryam , Khan Ejaz Ahmad , Khan Gulfaraz , Khan Md Nuruzzaman , Khatab Khaled , Khubchandani Jagdish , Kim Yun Jin , Kisa Adnan , Kisa Sezer , Kopec Jacek A. , Kosen Soewarta , Laxminarayana Sindhura Lakshmi Koulmane , Koyanagi Ai , Krishan Kewal , Defo Barthelemy Kuate , Kugbey Nuworza , Kulkarni Vaman , Kumar Manasi , Kumar Nithin , Kusuma Dian , La Vecchia Carlo , Lal Dharmesh Kumar , Landires Iván , Larson Heidi Jane , Lasrado Savita , Lee Paul H. , Li Shanshan , Liu Xuefeng , Maleki Afshin , Malik Preeti , Mansournia Mohammad Ali , Martins-Melo Francisco Rogerlândio , Mendoza Walter , Menezes Ritesh G. , Mengesha Endalkachew Worku , Meretoja Tuomo J. , Mestrovic Tomislav , Mirica Andreea , Moazen Babak , Mohamad Osama , Mohammad Yousef , Mohammadian-Hafshejani Abdollah , Mohammadpourhodki Reza , Mohammed Salahuddin , Mohammed Shafiu , Mokdad Ali H. , Moradi Masoud , Moraga Paula , Mubarik Sumaira , Mulu Getaneh Baye B. , Mwanri Lillian , Nagarajan Ahamarshan Jayaraman , Naimzada Mukhammad David , Naveed Muhammad , Nazari Javad , Ndejjo Rawlance , Negoi Ionut , Ngalesoni Frida N. , Nguefack-Tsague Georges , Ngunjiri Josephine W. , Nguyen Cuong Tat , Nguyen Huong Lan Thi , Nnaji Chukwudi A. , Noubiap Jean Jacques , Nuñez-Samudio Virginia , Nwatah Vincent Ebuka , Oancea Bogdan , Odukoya Oluwakemi Ololade , Olagunju Andrew T. , Olakunde Babayemi Oluwaseun , Olusanya Bolajoko Olubukunola , Olusanya Jacob Olusegun , Bali Ahmed Omar , Onwujekwe Obinna E. , Orisakwe Orish Ebere , Otstavnov Nikita , Otstavnov Stanislav S. , Owolabi Mayowa O. , Mahesh P. A. , Padubidri Jagadish Rao , Pana Adrian , Pandey Ashok , Pandi-Perumal Seithikurippu R. , Kan Fatemeh Pashazadeh , Patton George C. , Pawar Shrikant , Peprah Emmanuel K. , Postma Maarten J. , Preotescu Liliana , Syed Zahiruddin Quazi , Rabiee Navid , Radfar Amir , Rafiei Alireza , Rahim Fakher , Rahimi-Movaghar Vafa , Rahmani Amir Masoud , Ramezanzadeh Kiana , Rana Juwel , Ranabhat Chhabi Lal , Rao Sowmya J. , Rawaf David Laith , Rawaf Salman , Rawassizadeh Reza , Regassa Lemma Demissie , Rezaei Nima , Rezapour Aziz , Riaz Mavra A. , Ribeiro Ana Isabel , Ross Jennifer M. , Rubagotti Enrico , Rumisha Susan Fred , Rwegerera Godfrey M. , Moghaddam Sahar Saeedi , Sagar Rajesh , Sahiledengle Biniyam , Sahu Maitreyi , Salem Marwa Rashad , Kafil Hossein Samadi , Samy Abdallah M. , Sartorius Benn , Sathian Brijesh , Seidu Abdul-Aziz , Shaheen Amira A. , Shaikh Masood Ali , Shamsizadeh Morteza , Shiferaw Wondimeneh Shibabaw , Shin Jae Il , Shrestha Roman , Singh Jasvinder A. , Skryabin Valentin Yurievich , Skryabina Anna Aleksandrovna , Soltani Shahin , Sufiyan Mu’awiyyah Babale , Tabuchi Takahiro , Tadesse Eyayou Girma , Taveira Nuno , Tesfay Fisaha Haile , Thapar Rekha , Tovani-Palone Marcos Roberto , Tsegaye Gebiyaw Wudie , Umeokonkwo Chukwuma David , Unnikrishnan Bhaskaran , Villafañe Jorge Hugo , Violante Francesco S. , Vo Bay , Vu Giang Thu , Wado Yohannes Dibaba , Waheed Yasir , Wamai Richard G. , Wang Yanzhong , Ward Paul , Wickramasinghe Nuwan Darshana , Wilson Katherine , Yaya Sanni , Yip Paul , Yonemoto Naohiro , Yu Chuanhua , Zastrozhin Mikhail Sergeevich , Zhang Yunquan , Zhang Zhi-Jiang , Hay Simon I. , Dwyer-Lindgren Laura ,   on behalf of Local Burden of Disease sub-Saharan Africa HIV Prevalence Collaborators
Published: December 2022

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.