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Adult HIV-1 incidence across 15 high-burden countries in sub-Saharan Africa from 2015-2019: Pooled nationally representative estimates
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3 2023
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Source: Lancet HIV. 10(3):e175-e185
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Details:
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Alternative Title:Lancet HIV
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Personal Author:
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Description:Background:
Harmonized population-based surveys with recent HIV-1 infection testing algorithms permit pooled cross-sectional HIV incidence estimation across multiple countries. The objective of this analysis is to estimate adult HIV-1 incidence rates and number of new infections by sex, age, and sub-region in sub-Saharan Africa (SSA).
Methods:
We analyzed data from 13 Population-based HIV Impact Assessment (PHIA) surveys and two additional population-based surveys conducted between 2015 and 2019 in 15 SSA countries. HIV-seropositive samples from adults 15-59 years-old were tested for recent HIV-1 infection using an algorithm consisting of the HIV-1 Limiting Antigen Avidity enzyme immunoassay, HIV-1 viral load, and qualitative detection of antiretrovirals. Data were pooled across countries; sampling weights were incorporated to represent all adults in the 15 national populations. Analyses accounted for the complex sample designs. HIV incidence rates (IRs), IR differences, and number of new annual infections were estimated.
Findings:
Among 445,979 adults sampled, 382 had recent HIV-1 infection. Estimated HIV-1 incidence was 3·3/1,000 PYs (95% CI: 2·6, 4·0) among females and 2·0/1,000 PYs (95% CI: 1·2, 2·7) among males (IR difference: 1.3/1,000 PYs (95% CI: 0.3, 2.3). Among 15-24 year-old adults, the IR was higher for females than males (3·5 versus. 1·2/1,000 PYs; IR difference: 2·3, 95% CI: 0·8, 3·8), but infection rates were comparable between sexes in all other age groups. HIV-1 incidence was 7·4/1,000 PYs (95% CI: 5·0, 9·7) in Southern Africa, 2·3/1,000 PYs (95% CI: 1.7, 2.9) in Eastern Africa, and 0·9/1,000 PYs (95% CI: 0·6, 1·2) in West/Central Africa. Overall, 689,000 (95% CI: 546,000-833,000) new HIV cases were estimated annually among the 265 million susceptible adults—61.6% in females.
Interpretation:
These findings identify differences in HIV-1 incidence and new infections by age, sex, and sub-region. Approaches for risk stratification are needed to guide comprehensive HIV-1 prevention.
Funding:
National Institutes of Health
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Source:
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Pubmed ID:36702151
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Pubmed Central ID:PMC10126805
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Volume:10
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Issue:3
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