Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18: a modelling study. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Sartorius, Benn; VanderHeide, John D; Yang, Mingyou; Goosmann, Erik A; Hon, Julia; Haeuser, Emily; Cork, Michael A; Perkins, Samantha; Jahagirdar, Deepa; Schaeffer, Lauren E; Serfes, Audrey L; LeGrand, Kate E; Abbastabar, Hedayat; Abebo, Zeleke Hailemariam; Abosetugn, Akine Eshete; Abu-Gharbieh, Eman; Accrombessi, Manfred Mario Kokou; Adebayo, Oladimeji M; Adegbosin, Adeyinka Emmanuel; Adekanmbi, Victor; Adetokunboh, Olatunji O; Adeyinka, Daniel Adedayo; Ahinkorah, Bright Opoku; Ahmadi, Keivan; Ahmed, Muktar Beshir; Akalu, Yonas; Akinyemi, Oluwaseun Oladapo; Akinyemi, Rufus Olusola; Aklilu, Addis; Akunna, Chisom Joyqueenet; Alahdab, Fares; Al-Aly, Ziyad; Alam, Noore; Alamneh, Alehegn Aderaw; Alanzi, Turki M; Alemu, Biresaw Wassihun; Alhassan, Robert Kaba; Ali, Tilahun; Alipour, Vahid; Amini, Saeed; Ancuceanu, Robert; Ansari, Fereshteh; Anteneh, Zelalem Alamrew; Anvari, Davood; Anwer, Razique; Appiah, Seth Christopher Yaw; Arabloo, Jalal; Asemahagn, Mulusew A; Asghari Jafarabadi, Mohammad; Asmare, Wondwossen Niguse; Atnafu, Desta Debalkie; Atout, Maha Moh'd Wahbi; Atreya, Alok; Ausloos, Marcel; Awedew, Atalel Fentahun; Ayala Quintanilla, Beatriz Paulina; Ayanore, Martin Amogre; Aynalem, Yared Asmare; Ayza, Muluken Altaye; Azari, Samad; Azene, Zelalem Nigussie; Babar, Zaheer-Ud-Din; Baig, Atif Amin; Balakrishnan, Senthilkumar; Banach, Maciej; Bärnighausen, Till Winfried; Basu, Sanjay; Bayati, Mohsen; Bedi, Neeraj; Bekuma, Tariku Tesfaye; Bezabhe, Woldesellassie M Mequanint; Bhagavathula, Akshaya Srikanth; Bhardwaj, Pankaj; Bhattacharyya, Krittika; Bhutta, Zulfiqar A; Bibi, Sadia; Bikbov, Boris; Birhan, Tsegaye Adane; Bitew, Zebenay Workneh; Bockarie, Moses John; Boloor, Archith; Brady, Oliver J; Bragazzi, Nicola Luigi; Briko, Andrey Nikolaevich; Briko, Nikolay Ivanovich; Burugina Nagaraja, Sharath; Butt, Zahid A; Cárdenas, Rosario; Carvalho, Felix; Charan, Jaykaran; Chatterjee, Souranshu; Chattu, Soosanna Kumary; Chattu, Vijay Kumar; Chowdhury, Mohiuddin Ahsanul Kabir; Chu, Dinh-Toi; Cook, Aubrey J; Cormier, Natalie Maria; Cowden, Richard G; Culquichicon, Carlos; Dagnew, Baye; Dahlawi, Saad M A; Damiani, Giovanni; Daneshpajouhnejad, Parnaz; Daoud, Farah; Daryani, Ahmad; das Neves, José; Davis Weaver, Nicole; Derbew Molla, Meseret; Deribe, Kebede; Desta, Abebaw Alemayehu; Deuba, Keshab; Dharmaratne, Samath Dhamminda; Dhungana, Govinda Prasad; Diaz, Daniel; Djalalinia, Shirin; Doku, Paul Narh; Dubljanin, Eleonora; Duko, Bereket; Eagan, Arielle Wilder; Earl, Lucas; Eaton, Jeffrey W; Effiong, Andem; El Sayed Zaki, Maysaa; El Tantawi, Maha; Elayedath, Rajesh; El-Jaafary, Shaimaa I; Elsharkawy, Aisha; Eskandarieh, Sharareh; Eyawo, Oghenowede; Ezzikouri, Sayeh; Fasanmi, Abidemi Omolara; Fasil, Alebachew; Fauk, Nelsensius Klau; Feigin, Valery L; Ferede, Tomas Y; Fernandes, Eduarda; Fischer, Florian; Foigt, Nataliya A; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Francis, Joel Msafiri; Fukumoto, Takeshi; Gad, Mohamed M; Geberemariyam, Biniyam Sahiledengle; Gebregiorgis, Birhan Gebresillassie; Gebremichael, Berhe; Gesesew, Hailay Abrha; Getacher, Lemma; Ghadiri, Keyghobad; Ghashghaee, Ahmad; Gilani, Syed Amir; Ginindza, Themba G; Glagn, Mustefa; Golechha, Mahaveer; Gona, Philimon N; Gubari, Mohammed Ibrahim Mohialdeen; Gugnani, Harish Chander; Guido, Davide; Guled, Rashid Abdi; Hall, Brian J; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Hargono, Arief; Hashi, Abdiwahab; Hassanipour, Soheil; Hassankhani, Hadi; Hayat, Khezar; Herteliu, Claudiu; Hidru, Hagos Degefa de; Holla, Ramesh; Hosgood, H Dean; Hossain, Naznin; Hosseini, Mostafa; Hosseinzadeh, Mehdi; Househ, Mowafa; Hwang, Bing-Fang; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Irena M; Ilic, Milena D; Irvani, Seyed Sina Naghibi; Iwu, Chidozie C D; Iwu, Chinwe Juliana; Iyamu, Ihoghosa Osamuyi; Jain, Vardhmaan; Jakovljevic, Mihajlo; Jalilian, Farzad; Jha, Ravi Prakash; Johnson, Kimberly B; Joshua, Vasna; Joukar, Farahnaz; Jozwiak, Jacek Jerzy; Kabir, Ali; Kalankesh, Leila R; Kalhor, Rohollah; Kamath, Ashwin; Kamyari, Naser; Kanchan, Tanuj; Karami Matin, Behzad; Karch, André; Karimi, Salah Eddin; Kasa, Ayele Semachew; Kassahun, Getinet; Kayode, Gbenga A; Kazemi Karyani, Ali; Keiyoro, Peter Njenga; Kelkay, Bayew; Khalid, Nauman; Khan, Gulfaraz; Khan, Junaid; Khan, Md Nuruzzaman; Khatab, Khaled; Khazaei, Salman; Kim, Yun Jin; Kisa, Adnan; Kisa, Sezer; Kochhar, Sonali; Kopec, Jacek A; Kosen, Soewarta; Koulmane Laxminarayana, Sindhura Lakshmi; Koyanagi, Ai; Krishan, Kewal; Kuate Defo, Barthelemy; Kugbey, Nuworza; Kulkarni, Vaman; Kumar, Manasi; Kumar, Nithin; Kurmi, Om P; Kusuma, Dian; Kuupiel, Desmond; Kyu, Hmwe Hmwe; La Vecchia, Carlo; Lal, Dharmesh Kumar; Lam, Jennifer O; Landires, Iván; Lasrado, Savita; Lazarus, Jeffrey V; Lazzar-Atwood, Alice; Lee, Paul H; Leshargie, Cheru Tesema; Li, Bingyu; Liu, Xuefeng; Lopukhov, Platon D; M. Amin, Hawraz Ibrahim; Madi, Deepak; Mahasha, Phetole Walter; Majeed, Azeem; Maleki, Afshin; Maleki, Shokofeh; Mamun, Abdullah A; Manafi, Navid; Mansournia, Mohammad Ali; Martins-Melo, Francisco Rogerlândio; Masoumi, Seyedeh Zahra; Mayala, Benjamin K; Meharie, Birhanu Geta; Meheretu, Hailemariam Abiy Alemu; Meles, Hagazi Gebre; Melku, Mulugeta; Mendoza, Walter; Mengesha, Endalkachew Worku; Meretoja, Tuomo J; Mersha, Abera M; Mestrovic, Tomislav; Miller, Ted R; Mirica, Andreea; Mirzaei-Alavijeh, Mehdi; Mohamad, Osama; Mohammad, Yousef; Mohammadian-Hafshejani, Abdollah; Mohammed, Jemal Abdu; Mohammed, Salahuddin; Mohammed, Shafiu; Mokdad, Ali H; Mokonnon, Taklu Marama; Molokhia, Mariam; Moradi, Masoud; Moradi, Yousef; Moradzadeh, Rahmatollah; Moraga, Paula; Mosser, Jonathan F; Munro, Sandra B; Mustafa, Ghulam; Muthupandian, Saravanan; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naghavi, Mohsen; Naveed, Muhammad; Nayak, Vinod C; Nazari, Javad; Ndejjo, Rawlance; Nepal, Samata; Netsere, Henok Biresaw; Ngalesoni, Frida N; Nguefack-Tsague, Georges; Ngunjiri, Josephine W; Nigatu, Yeshambel T; Nigussie, Samuel Negash; Nnaji, Chukwudi A; Noubiap, Jean Jacques; Nuñez-Samudio, Virginia; Oancea, Bogdan; Odukoya, Oluwakemi Ololade; Ogbo, Felix Akpojene; Oladimeji, Olanrewaju; Olagunju, Andrew T; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Omer, Muktar Omer; Omonisi, Abidemi E Emmanuel; Onwujekwe, Obinna E; Orisakwe, Orish Ebere; Otstavnov, Nikita; Owolabi, Mayowa O; P A, Mahesh; Padubidri, Jagadish Rao; Pakhale, Smita; Pana, Adrian; Pandi-Perumal, Seithikurippu R; Patel, Urvish K; Pathak, Mona; Patton, George C; Pawar, Shrikant; Peprah, Emmanuel K; Pokhrel, Khem Narayan; Postma, Maarten J; Pottoo, Faheem Hyder; Pourjafar, Hadi; Pribadi, Dimas Ria Angga; Quazi Syed, Zahiruddin; Rafiei, Alireza; Rahim, Fakher; Rahman, Mohammad Hifz Ur; Rahmani, Amir Masoud; Ram, Pradhum; Rana, Juwel; Ranabhat, Chhabi Lal; Rao, Satish; Rao, Sowmya J; Rathi, Priya; Rawaf, David Laith; Rawaf, Salman; Rawassizadeh, Reza; Renjith, Vishnu; Reta, Melese Abate; Rezaei, Nima; Rezapour, Aziz; Ribeiro, Ana Isabel; Ross, Jennifer M; Rumisha, Susan Fred; Sagar, Rajesh; Sahu, Maitreyi; Sajadi, S. Mohammad; Salem, Marwa Rashad; Samy, Abdallah M; Sathian, Brijesh; Schutte, Aletta Elisabeth; Seidu, Abdul-Aziz; Sha, Feng; Shafaat, Omid; Shahbaz, Mohammad; Shaikh, Masood Ali; Shaka, Mohammed Feyisso; Sheikh, Aziz; Shibuya, Kenji; Shin, Jae Il; Shivakumar, K M; Sidemo, Negussie Boti; Singh, Jasvinder A; Skryabin, Valentin Yurievich; Skryabina, Anna Aleksandrovna; Soheili, Amin; Soltani, Shahin; Somefun, Oluwaseyi Dolapo; Sorrie, Muluken Bekele; Spurlock, Emma Elizabeth; Sufiyan, Mu'awiyyah Babale; Taddele, Biruk Wogayehu; Tadesse, Eyayou Girma; Tamir, Zemenu; Tamiru, Animut Tagele; Tanser, Frank C; Taveira, Nuno; Tehrani-Banihashemi, Arash; Tekalegn, Yohannes; Tesfay, Fisaha Haile; Tessema, Belay; Tessema, Zemenu Tadesse; Thakur, Bhaskar; Tolani, Musliu Adetola; Topor-Madry, Roman; Torrado, Marco; Tovani-Palone, Marcos Roberto; Traini, Eugenio; Tsai, Alexander C; Tsegaye, Gebiyaw Wudie; Ullah, Irfan; Ullah, Saif; Umeokonkwo, Chukwuma David; Unnikrishnan, Bhaskaran; Vardavas, Constantine; Violante, Francesco S; Vo, Bay; Wado, Yohannes Dibaba; Waheed, Yasir; Wamai, Richard G; Wang, Yanzhong; Ward, Paul; Werdecker, Andrea; Wickramasinghe, Nuwan Darshana; Wijeratne, Tissa; Wiysonge, Charles Shey; Wondmeneh, Temesgen Gebeyehu; Yamada, Tomohide; Yaya, Sanni; Yeshaw, Yigizie; Yeshitila, Yordanos Gizachew; Yilma, Mekdes Tigistu; Yip, Paul; Yonemoto, Naohiro; Yosef, Tewodros; Yusefzadeh, Hasan; Zaidi, Syed Saoud; Zaki, Leila; Zamanian, Maryam; Zastrozhin, Mikhail Sergeevich; Zastrozhina, Anasthasia; Zewdie, Dejene Tesfaye; Zhang, Yunquan; Zhang, Zhi-Jiang; Ziapour, Arash; Hay, Simon I; Dwyer-Lindgren, Laura;
• Is Part Of: Lancet. Volume 8:Issue 6(2021)
• Page Start: e363
• Page End: e375
• Publication Date: 2021-06
• Subjects: HIV (Viruses) -- Periodicals; HIV infections -- Periodicals; AIDS (Disease) -- Periodicals; 616.9792
• DOI: 10.1016/S2352-3018(21)00051-5
• Languages: English
• ISSNs: 2405-4704

Abstract

Summary: 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.