article · BMC Medicine
High-resolution mapping reveals substantial variation in HIV prevalence across age, sex, and geography in sub-Saharan Africa between 2000 and 2018. Analysing data from 91 seroprevalence surveys and antenatal care sentinel surveillance across 43 countries, local estimates were produced at a five-by-five kilometre resolution for adults aged 15 to 59 years. In 2018, within-country variation across specific age and sex groups was a median 3.5 times greater than when considering all adults together. Half of all analysed districts showed at least a 14-fold difference in prevalence between age groups for men, and at least a nine-fold difference for women. While 70 percent of districts experienced reductions of over five percentage points in at least one demographic group, over 30 percent saw increases of a similar magnitude. These fine-scale estimates provide detailed epidemiological insight to guide tailored public health prevention and treatment programmes across the region.
Standard national statistics can conceal severe disparities in HIV rates between neighbouring districts and different demographic groups. By uncovering how infection rates differ down to local districts and specific age brackets, health organisations and policymakers can allocate limited funding, medicines, and prevention programmes precisely where they are needed most to curb ongoing disease transmission.
These epidemiological models and local data estimates serve as public health planning tools for government health ministries, international donors, and non-governmental organisations designing targeted healthcare programmes. The methodology represents applied research that is directly usable for strategic healthcare resource allocation and intervention design, though the abstract does not indicate any commercial product development or private sector business pathway.
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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.
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DOI: 10.1186/s12916-022-02639-z
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