Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017

Laura Dwyer-Lindgren,Robert C Reiner,Michael A Cork,Aniruddha Deshpande,Jennifer M Ross,David L Smith,Nathaniel J Henry,Krista M Steuben,Lauren E Schaeffer,Christopher J L Murray ,Alex Opio,Peter Piot,Charbel El Bcheraoui,Benjamin K Mayala,Amber Sligar,Nicole Davis Weaver,Kirsten E Wiens,Jeffrey W Eaton,Aaron Osgood‐Zimmerman ,Austin Carter,Jason Hall ,Daniel Casey ,Benn Sartorius,Dirk Douwes‐Schultz ,Kate Wilson ,Lucas Earl,Naomi R Provost,Tamer H Farag,Frank Tanser,Tahvi Frank,Jessica Justman ,David M Pigott ,Molly H Biehl ,Michael Collison ,John D Vanderheide,Damaris K Kinyoki ,Roy Burstein,Laurie B Marczak,Molly R Nixon ,Njeri Wabiri,Simon I Hay

doi:10.1038/s41586-019-1200-9

Abstract

HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15–49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa.

Highlights

HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa
Local estimates of HIV prevalence— the number of people living with HIV—are useful for estimating the location-specific need for anti-retroviral therapy (ART) and other HIV-related services, and complement routinely collected clinical data that in some locations provide estimates of the number of
This study provides a comprehensive quantification of subnational trends in HIV prevalence and the number of people living with HIV

Summary

Discussion

Despite progress in recent decades, HIV continues to impose a substantial health burden on countries in sub-Saharan Africa The estimates from this analysis highlight the degree to which the effect of this epidemic varies, even within countries. These local data provide a new tool for policymakers, programme implementers and researchers to use to assess local needs, efficiently target interventions and work towards bringing HIV infection under control in Africa. G. et al Mortality trends in the era of antiretroviral therapy: evidence from the Network for Analysing Longitudinal Population based HIV/AIDS data on Africa (ALPHA). Regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Global Lakes and Wetlands Database Level 3. https://www. worldwildlife.org/pages/global-lakes-and-wetlands-database (World Wildlife Fund, 2004)

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