HIV incidence in sub-Saharan Africa ‘appears low,’ but rates remain ‘staggering’
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Despite some progress being made, sub-Saharan Africa remained a hot spot for new HIV infections, with approximately 689,000 new infections annually among HIV-negative adults between 2015 and 2019, according to data pooled from 15 countries.
“We were surprised that there [were] no empirical data characterizing HIV incidence in sub-Saharan Africa,” Nora E. Rosenberg, PhD, MSP, associate professor in the Gillings School of Global Public Health’s department of health behavior at the University of North Carolina at Chapel Hill, told Healio.
“These 15 nationally representative datasets provided an opportunity to characterize HIV incidence across much of the continent,” she said.
For the study, Rosenberg and colleagues analyzed data from 13 Population-based HIV Impact Assessment surveys, as well as two additional population-based surveys conducted between 2015 and 2019 in 15 sub-Saharan African countries.
HIV-seropositive samples collected from adults aged 15 to 59 years and older were tested for recent infection using an algorithm consisting of the HIV-1-limiting antigen avidity enzyme immunoassay, HIV-1 viral load and qualitative detection of antiretroviral agents. Data were then pooled across countries, and sampling weights were incorporated to represent all adults in the 15 national populations.
Among 445,979 adults sampled, 382 had recent HIV-1 infection, generating an estimated HIV-1 incidence rate of 3.3 per 1,000 person-years (95% CI, 2.6-4) among women and 2 per 1,000 person-years (95% CI, 1.2-2.7) among men (incidence rate difference: 1.3 per 1,000 person-years; 95% CI, 0.3-2.3).
In an age-adjusted analysis, the study demonstrated that the incidence rate was higher among women aged 15 to 24 years (3.5 per 1,000 person-years) than among men (3.5 vs. 1.2 per 1,000 person-years; difference of 2.3, 95% CI, 0.8-3.8), although infection rates were similar between sexes in all other age groups.
When broken down by location, the study showed that the HIV-1 incidence rate was 7.4 per 1,000 person-years (95% CI, 5-9.7) in southern sub-Saharan Africa, 2.3 per 1,000 person-years (95% CI, 1.7-2.9) in the eastern subregion and 0.9 per 1,000 person-years (95% CI, 0.6-1.2) in the western and central subregion.
Rosenberg said that although these rates “may appear low,” they translate to approximately 689,000 adult infections each year, which she said is a “staggering number.”
In a related comment, Sabin Nsanzimana, MD, MSc, PhD, and Edward J. Mills, PhD, of the University Teaching Hospital of Butare and McMaster University, respectively, wrote that sub-Saharan Africa “remains the epicenter” of the HIV pandemic and the overall estimates indicate that the pandemic is not slowing.
“Nearly 40 years on, the commitment to end AIDS by 2030 requires more than words; it requires innovative ways to detect new infections in real time using methods that adapt with the populations they target,” they wrote.
Rosenberg added to this saying that despite 2 decades of HIV programming in sub-Saharan Africa, the HIV epidemic “continues to smolder.”
“There is an urgent need for finding the people at greatest risk of acquiring HIV and supporting them with effective HIV prevention strategies,” she said.
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