Adult HIV-1 incidence across 15 high-burden countries in sub-Saharan Africa from 2015 to 2019: a pooled analysis of nationally representative data

Nora E Rosenberg; Bonnie E Shook-Sa; Mincen Liu; Lynda Stranix-Chibanda; Marcel Yotebieng; Nadia A Sam-Agudu; Michael G Hudgens; Sam J Phiri; Wilbroad Mutale; Linda-Gail Bekker; Sizulu Moyo; Khangelani Zuma; Manhattan E Charurat; Jessica Justman; Benjamin H Chi

doi:10.1016/S2352-3018(22)00328-9

Adult HIV-1 incidence across 15 high-burden countries in sub-Saharan Africa from 2015 to 2019: a pooled analysis of nationally representative data

Lancet HIV. 2023 Mar;10(3):e175-e185. doi: 10.1016/S2352-3018(22)00328-9. Epub 2023 Jan 23.

Authors

Affiliations

¹ Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: nora_rosenberg@unc.edu.
² Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe; University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
⁴ Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
⁵ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA; International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
⁶ Partners in Hope, Lilongwe, Malawi; Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi.
⁷ University of Zambia, Lusaka, Zambia.
⁸ University of Cape Town, Cape Town, South Africa.
⁹ University of Cape Town, Cape Town, South Africa; Human Sciences Research Council, Pretoria, South Africa.
¹⁰ Human Sciences Research Council, Pretoria, South Africa.
¹¹ Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
¹² ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, NY, USA.
¹³ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Background: Harmonised population-based surveys with recent HIV-1 infection testing algorithms permit pooled cross-sectional estimation of HIV incidence across multiple countries. We aimed to estimate adult HIV-1 incidence rates and number of new infections by sex, age, and subregion in sub-Saharan Africa.

Methods: We analysed data from 13 Population-Based HIV Impact Assessment (PHIA) surveys and two additional population-based surveys done between 2015 and 2019 in 15 sub-Saharan African countries. HIV-seropositive samples from adults aged 15-59 years were tested for recent HIV-1 infection by use of an algorithm consisting of the HIV-1 limiting antigen avidity enzyme immunoassay, HIV-1 viral load, and qualitative detection of antiretroviral agents. 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, incidence rate differences, and number of new annual infections were estimated.

Findings: Among 445 979 adults sampled, 382 had recent HIV-1 infection. The estimated HIV-1 incidence rate was 3·3 per 1000 person-years (95% CI 2·6-4·0) among women and 2·0 per 1000 person-years (1·2-2·7) among men (incidence rate difference 1·3 per 1000 person-years, 95% CI 0·3-2·3). Among adults aged 15-24 years, the incidence rate was higher for women (3·5 per 1000 person-years) than men (1·2 per 1000 person-years; difference 2·3, 95% CI 0·8-3·8), but infection rates were similar between sexes in all other age groups. The HIV-1 incidence rate was 7·4 per 1000 person-years (95% CI 5·0-9·7) in southern sub-Saharan Africa, 2·3 per 1000 person-years (1·7-2·9) in the eastern subregion, and 0·9 per 1000 person-years (0·6-1·2) in the western and central subregion. 689 000 (95% CI 546 000-833 000) new HIV cases were estimated annually among the 265 million susceptible adults (61·6% in women).

Interpretation: HIV-1 incidence and number of new infections differed by age, sex, and subregion. Approaches for risk stratification are needed to guide comprehensive HIV-1 prevention.

Funding: National Institutes of Health.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Acquired Immunodeficiency Syndrome*
Adult
Africa South of the Sahara
Cross-Sectional Studies
Female
HIV Infections* / epidemiology
HIV Seropositivity*
HIV-1*
Humans
Incidence
Male

Abstract

Publication types

MeSH terms

Grants and funding