Declining HIV incidence in sub‐Saharan Africa: a systematic review and meta‐analysis of empiric data

Joshi, Keya; Lessler, Justin; Olawore, Oluwasolape; Loevinsohn, Gideon; Bushey, Sophrena; Tobian, Aaron A.R.; Grabowski, M Kate

doi:10.1002/jia2.25818

Cited by 42 publications

(30 citation statements)

References 26 publications

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“…Our results indicate that, in a hyperendemic South African setting, incidence was high even among women who reported few individual-level risk factors. Similar gender disparities have been demonstrated across sub-Saharan Africa [ 28 ], and our findings underscore the continuing need for widespread coverage of combination HIV prevention services, especially for women.…”

Section: Discussionsupporting

confidence: 85%

Predicting the Risk of Human Immunodeficiency Virus Type 1 (HIV-1) Acquisition in Rural South Africa Using Geospatial Data

Roberts

Cuadros

Vandormael

et al. 2022

Clinical Infectious Diseases

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Background Accurate HIV risk assessment can guide optimal HIV prevention. We evaluated the performance of risk prediction models incorporating geospatial measures. Methods We developed and validated HIV risk prediction models in a population-based cohort in South Africa. Individual-level covariates included demographic and sexual behavior measures, and geospatial covariates included community HIV prevalence and viral load estimates. We trained models on 2012-2015 data using LASSO Cox models and validated predictions on 2016-2019 data. We compared full models to simpler models restricted to only individual-level covariates or only age and geospatial covariates. We compared the spatial distribution of predicted risk to that of high incidence areas (≥ 3/100 person-years (PY)). Results Our analysis included 19,556 individuals contributing 44,871 PY and 1,308 seroconversions. Incidence among the highest predicted risk quintile using the full model was 6.6/100 PY (women) and 2.8/100 PY (men). Models using only age group and geospatial covariates had similar performance (women: AUROC = 0.65, men: AUROC = 0.71) to the full models (women: AUROC = 0.68, men: AUROC = 0.72). Geospatial models more accurately identified high incidence regions than individual-level models; the 20% of the study area with the highest predicted risk accounted for 60% of the high incidence areas when using geospatial models but only 13% using models with only individual-level covariates. Conclusions Geospatial models with no individual measures other than age group predicted HIV risk nearly as well as models that included detailed behavioral data. Geospatial models may help guide HIV prevention efforts to individuals and geographic areas at highest risk.

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Section: Discussionsupporting

confidence: 85%

Predicting the Risk of Human Immunodeficiency Virus Type 1 (HIV-1) Acquisition in Rural South Africa Using Geospatial Data

Roberts

Cuadros

Vandormael

et al. 2022

Clinical Infectious Diseases

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“…Prioritisation does not preclude choice and appropriateness of HIV prevention nor is it a rigid process, but rather a means to allow programme staff and policy makers to maximise the equity, utility, and impact of prevention services. Furthermore, as HIV incidence continues to decline, the importance of prioritisation will increase [ 45 ].…”

Section: The New Target and Approaches For Hiv Preventionmentioning

confidence: 99%

HIV prevention for the next decade: Appropriate, person-centred, prioritised, effective, combination prevention

et al. 2022

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UNAIDS and a broad range of partners have collaborated to establish a new set of HIV prevention targets to be achieved by 2025 as an intermediate step towards the sustainable development target for 2030. The number of new HIV infections in the world continues to decline, in part due to the extraordinary expansion of effective HIV treatment. However, the decline is geographically heterogeneous, with some regions reporting a rise in incidence. The incidence target that was agreed for 2020 has been missed. A range of exciting new HIV prevention technologies have become available or are in the pipeline but will only have an impact if they are accessible and affordable and delivered within systems that take full account of the social and political context in which most infections occur. Most new infections occur in populations that are marginalised or discriminated against due to structural, legal, and cultural barriers. The new targets imply a new approach to HIV prevention that emphasises appropriate, person-centred, prioritised, effective, combination HIV prevention within a framework that reduces existing barriers to services and acknowledges heterogeneity, autonomy, and choice. These targets have consequences for people working in HIV programmes both for delivery and for monitoring and evaluation, for health planners setting local and national priorities, and for funders both domestic and global. Most importantly, they have consequences for people who are at risk of HIV exposure and infection. Achieving these targets will have a huge impact on the future of the HIV epidemic and put us back on track towards ending AIDS as a public health threat by 2030.

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“…Previous studies conducted in other cities in China had shown a pretty high HIV incidence rate among MSM: 6.6 per 100 PY in Hangzhou, 34 6.78 per 100 PY in Yangzhou, 5.77 per 100 PY in Guangzhou, 35 5.3 per 100 PY in Shenyang, 36 5.12 per 100 PY in Nanjing, 37 3.5 per 100 PY in Yunnan 38 and 7.1 per 100 PY in Beijing. 39 The incidence is also at a low level compared with related studies in other regions (sub-Saharan Africa, 40 Latin America 41 and the USA 42–44 ). In this study, the percentage of ‘protective’ and ‘moderate’ behaviour types had a conspicuous growth trend as the follow-up.…”

Section: Discussionmentioning

confidence: 79%

Sexual behaviour changes and HIV infection among men who have sex with men: evidence from an open cohort in China

Zhang

Wang

et al. 2022

BMJ Open

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BackgroundThe HIV epidemic in key populations such as men who have sex with men (MSM) is a public health issue of worldwide concern. China has seen an increase in newly diagnosed HIV infections through male–male sexual contact in the past decade. In a long-term cohort, how the complex behaviour pattern of MSM changed and the association with the HIV risk are unclear at present.MethodsThis study was conducted from October 2011 to December 2019 in Tianjin. MSM were recruited by snowball sampling through online and offline ways. Demographic and sexual behavioural data were collected for analysis. Three indicators (condom use in last anal sex, frequency of condom use during anal sex and the number of sexual partners) were used to define the behaviour change. Participants with zero, one, and two or three risk indicators were categorised into behaviour types of ‘protective’, ‘moderate’, and ‘fragile’, respectively. Change in behaviour type between baseline and each visit was considered. Time-varying Cox models were performed to evaluate HIV infection risk.ResultsOf 2029 MSM included in the study, 127 were new HIV diagnoses. The overall incidence rate was 3.36 per 100 person-years. The percentage of ‘protective’ and ‘moderate’ behaviour types had a conspicuous growth trend as the follow-up. Furthermore, the HIV incidence rate in each visit among different behaviour transition types showed a general downward trend as the number of total follow-up times increased. Individuals who remained in ‘fragile’ (adjusted HR (aHR): 25.86, 95% CI: 6.92 to 96.57) or changed from ‘protective’ to ‘moderate’ (aHR: 4.79, 95% CI: 1.18 to 19.47), ‘protective’ to ‘fragile’ (aHR: 23.03, 95% CI: 6.02 to 88.13), and ‘moderate’ to ‘fragile’ (aHR: 25.48, 95% CI: 6.79 to 95.40) between baseline and the last follow-up had a higher HIV risk. Gained risk indicators were associated with the increase of HIV risk (gained one indicator, aHR: 2.67, 95% CI: 1.68 to 4.24; gained two or three indicators, aHR: 4.99, 95% CI: 3.00 to 8.31) while losing just one risk indicator could halve the risk (aHR: 0.43, 95% CI: 0.21 to 0.90).ConclusionsAmong MSM in Tianjin, it is necessary to get timely behaviour change for those with high-incidence behaviour patterns while sustaining for those with low-incidence patterns.Trial registration numberChinese Clinical Trials Registry (ChiCTR2000039500).

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Declining HIV incidence in sub‐Saharan Africa: a systematic review and meta‐analysis of empiric data

Cited by 42 publications

References 26 publications

Predicting the Risk of Human Immunodeficiency Virus Type 1 (HIV-1) Acquisition in Rural South Africa Using Geospatial Data

Predicting the Risk of Human Immunodeficiency Virus Type 1 (HIV-1) Acquisition in Rural South Africa Using Geospatial Data

HIV prevention for the next decade: Appropriate, person-centred, prioritised, effective, combination prevention

Sexual behaviour changes and HIV infection among men who have sex with men: evidence from an open cohort in China

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