TY - JOUR
T1 - Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18
T2 - a modelling study
AU - LBD HIV Incidence Mortality Collaborators
AU - Sartorius, Benn
AU - VanderHeide, John D.
AU - Yang, Mingyou
AU - Goosmann, Erik A.
AU - Hon, Julia
AU - Haeuser, Emily
AU - Cork, Michael A.
AU - Perkins, Samantha
AU - Jahagirdar, Deepa
AU - Schaeffer, Lauren E.
AU - Serfes, Audrey L.
AU - LeGrand, Kate E.
AU - Abbastabar, Hedayat
AU - Abebo, Zeleke Hailemariam
AU - Abosetugn, Akine Eshete
AU - Abu-Gharbieh, Eman
AU - Accrombessi, Manfred Mario Kokou
AU - Adebayo, Oladimeji M.
AU - Adegbosin, Adeyinka Emmanuel
AU - Adekanmbi, Victor
AU - Adetokunboh, Olatunji O.
AU - Adeyinka, Daniel Adedayo
AU - Ahinkorah, Bright Opoku
AU - Ahmadi, Keivan
AU - Ahmed, Muktar Beshir
AU - Akalu, Yonas
AU - Akinyemi, Oluwaseun Oladapo
AU - Akinyemi, Rufus Olusola
AU - Aklilu, Addis
AU - Akunna, Chisom Joyqueenet
AU - Alahdab, Fares
AU - Al-Aly, Ziyad
AU - Alam, Noore
AU - Alamneh, Alehegn Aderaw
AU - Alanzi, Turki M.
AU - Alemu, Biresaw Wassihun
AU - Alhassan, Robert Kaba
AU - Ali, Tilahun
AU - Alipour, Vahid
AU - Amini, Saeed
AU - Ancuceanu, Robert
AU - Ansari, Fereshteh
AU - Anteneh, Zelalem Alamrew
AU - Anvari, Davood
AU - Anwer, Razique
AU - Appiah, Seth Christopher Yaw
AU - Arabloo, Jalal
AU - Asemahagn, Mulusew A.
AU - Asghari Jafarabadi, Mohammad
AU - Asmare, Wondwossen Niguse
AU - Atnafu, Desta Debalkie
AU - Atout, Maha Moh'd Wahbi
AU - Atreya, Alok
AU - Ausloos, Marcel
AU - Awedew, Atalel Fentahun
AU - Ayala Quintanilla, Beatriz Paulina
AU - Ayanore, Martin Amogre
AU - Aynalem, Yared Asmare
AU - Ayza, Muluken Altaye
AU - Azari, Samad
AU - Azene, Zelalem Nigussie
AU - Babar, Zaheer Ud Din
AU - Baig, Atif Amin
AU - Balakrishnan, Senthilkumar
AU - Banach, Maciej
AU - Bärnighausen, Till Winfried
AU - Basu, Sanjay
AU - Bayati, Mohsen
AU - Bedi, Neeraj
AU - Bekuma, Tariku Tesfaye
AU - Bezabhe, Woldesellassie M.Mequanint
AU - Bhagavathula, Akshaya Srikanth
AU - Bhardwaj, Pankaj
AU - Bhattacharyya, Krittika
AU - Bhutta, Zulfiqar A.
AU - Bibi, Sadia
AU - Bikbov, Boris
AU - Birhan, Tsegaye Adane
AU - Bitew, Zebenay Workneh
AU - Bockarie, Moses John
AU - Boloor, Archith
AU - Brady, Oliver J.
AU - Bragazzi, Nicola Luigi
AU - Briko, Andrey Nikolaevich
AU - Briko, Nikolay Ivanovich
AU - Burugina Nagaraja, Sharath
AU - Butt, Zahid A.
AU - Cárdenas, Rosario
AU - Carvalho, Felix
AU - Charan, Jaykaran
AU - Chatterjee, Souranshu
AU - Chattu, Soosanna Kumary
AU - Chattu, Vijay Kumar
AU - Chowdhury, Mohiuddin Ahsanul Kabir
AU - Chu, Dinh Toi
AU - Cook, Aubrey J.
AU - Cormier, Natalie Maria
AU - Cowden, Richard G.
AU - Culquichicon, Carlos
AU - Dagnew, Baye
AU - Dahlawi, Saad M.A.
AU - Damiani, Giovanni
AU - Daneshpajouhnejad, Parnaz
AU - Daoud, Farah
AU - Daryani, Ahmad
AU - das Neves, José
AU - Davis Weaver, Nicole
AU - Derbew Molla, Meseret
AU - Deribe, Kebede
AU - Desta, Abebaw Alemayehu
AU - Deuba, Keshab
AU - Dharmaratne, Samath Dhamminda
AU - Dhungana, Govinda Prasad
AU - Diaz, Daniel
AU - Djalalinia, Shirin
AU - Doku, Paul Narh
AU - Dubljanin, Eleonora
AU - Duko, Bereket
AU - Eagan, Arielle Wilder
AU - Earl, Lucas
AU - Eaton, Jeffrey W.
AU - Effiong, Andem
AU - El Sayed Zaki, Maysaa
AU - El Tantawi, Maha
AU - Elayedath, Rajesh
AU - El-Jaafary, Shaimaa I.
AU - Elsharkawy, Aisha
AU - Eskandarieh, Sharareh
AU - Eyawo, Oghenowede
AU - Ezzikouri, Sayeh
AU - Fasanmi, Abidemi Omolara
AU - Fasil, Alebachew
AU - Fauk, Nelsensius Klau
AU - Feigin, Valery L.
AU - Ferede, Tomas Y.
AU - Fernandes, Eduarda
AU - Fischer, Florian
AU - Foigt, Nataliya A.
AU - Folayan, Morenike Oluwatoyin
AU - Foroutan, Masoud
AU - Francis, Joel Msafiri
AU - Fukumoto, Takeshi
AU - Gad, Mohamed M.
AU - Geberemariyam, Biniyam Sahiledengle
AU - Gebregiorgis, Birhan Gebresillassie
AU - Gebremichael, Berhe
AU - Gesesew, Hailay Abrha
AU - Getacher, Lemma
AU - Ghadiri, Keyghobad
AU - Ghashghaee, Ahmad
AU - Gilani, Syed Amir
AU - Ginindza, Themba G.
AU - Glagn, Mustefa
AU - Golechha, Mahaveer
AU - Gona, Philimon N.
AU - Gubari, Mohammed Ibrahim Mohialdeen
AU - Gugnani, Harish Chander
AU - Guido, Davide
AU - Guled, Rashid Abdi
AU - Hall, Brian J.
AU - Hamidi, Samer
AU - Handiso, Demelash Woldeyohannes
AU - Hargono, Arief
AU - Hashi, Abdiwahab
AU - Hassanipour, Soheil
AU - Hassankhani, Hadi
AU - Hayat, Khezar
AU - Herteliu, Claudiu
AU - de Hidru, Hagos Degefa
AU - Holla, Ramesh
AU - Hosgood, H. Dean
AU - Hossain, Naznin
AU - Hosseini, Mostafa
AU - Hosseinzadeh, Mehdi
AU - Househ, Mowafa
AU - Hwang, Bing Fang
AU - Ibitoye, Segun Emmanuel
AU - Ilesanmi, Olayinka Stephen
AU - Ilic, Irena M.
AU - Ilic, Milena D.
AU - Irvani, Seyed Sina Naghibi
AU - Iwu, Chidozie C.D.
AU - Iwu, Chinwe Juliana
AU - Iyamu, Ihoghosa Osamuyi
AU - Jain, Vardhmaan
AU - Jakovljevic, Mihajlo
AU - Jalilian, Farzad
AU - Jha, Ravi Prakash
AU - Johnson, Kimberly B.
AU - Joshua, Vasna
AU - Joukar, Farahnaz
AU - Jozwiak, Jacek Jerzy
AU - Kabir, Ali
AU - Kalankesh, Leila R.
AU - Kalhor, Rohollah
AU - Kamath, Ashwin
AU - Kamyari, Naser
AU - Kanchan, Tanuj
AU - Karami Matin, Behzad
AU - Karch, André
AU - Karimi, Salah Eddin
AU - Kasa, Ayele Semachew
AU - Kassahun, Getinet
AU - Kayode, Gbenga A.
AU - Kazemi Karyani, Ali
AU - Keiyoro, Peter Njenga
AU - Kelkay, Bayew
AU - Khalid, Nauman
AU - Khan, Gulfaraz
AU - Khan, Junaid
AU - Khan, Md Nuruzzaman
AU - Khatab, Khaled
AU - Khazaei, Salman
AU - Kim, Yun Jin
AU - Kisa, Adnan
AU - Kisa, Sezer
AU - Kochhar, Sonali
AU - Kopec, Jacek A.
AU - Kosen, Soewarta
AU - Koulmane Laxminarayana, Sindhura
AU - Koyanagi, Ai
AU - Krishan, Kewal
AU - Kuate Defo, Barthelemy
AU - Kugbey, Nuworza
AU - Kulkarni, Vaman
AU - Kumar, Manasi
AU - Kumar, Nithin
AU - Kurmi, Om P.
AU - Kusuma, Dian
AU - Kuupiel, Desmond
AU - Kyu, Hmwe Hmwe
AU - La Vecchia, Carlo
AU - Lal, Dharmesh Kumar
AU - Lam, Jennifer O.
AU - Landires, Iván
AU - Lasrado, Savita
AU - Lazarus, Jeffrey V.
AU - Lazzar-Atwood, Alice
AU - Lee, Paul H.
AU - Leshargie, Cheru Tesema
AU - Li, Bingyu
AU - Liu, Xuefeng
AU - Lopukhov, Platon D.
AU - Amin, Hawraz Ibrahim M.
AU - Madi, Deepak
AU - Mahasha, Phetole Walter
AU - Majeed, Azeem
AU - Maleki, Afshin
AU - Tesfay, Fisaha Haile
AU - Ward, Paul
PY - 2021/6
Y1 - 2021/6
N2 - Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas. Funding: Bill & Melinda Gates Foundation.
AB - Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas. Funding: Bill & Melinda Gates Foundation.
KW - Burden of disease
KW - HIV incidence
KW - HIV mortality
KW - sub-Saharan Africa
KW - HIV burden
UR - http://www.scopus.com/inward/record.url?scp=85107089020&partnerID=8YFLogxK
U2 - 10.1016/S2352-3018(21)00051-5
DO - 10.1016/S2352-3018(21)00051-5
M3 - Article
C2 - 34087097
AN - SCOPUS:85107089020
SN - 2352-3018
VL - 8
SP - e363-e375
JO - The Lancet HIV
JF - The Lancet HIV
IS - 6
ER -