Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study

Benn Sartorius; John D. VanderHeide; Mingyou Yang; Erik A. Goosmann; Julia Hon; Emily Haeuser; Michael A. Cork; Samantha Perkins; Deepa Jahagirdar; Lauren E. Schaeffer; Audrey L. Serfes; Kate E. LeGrand; Hedayat Abbastabar; Zeleke Hailemariam Abebo; Akine Eshete Abosetugn; Eman Abu-Gharbieh; Manfred Mario Kokou Accrombessi; Oladimeji M. Adebayo; Adeyinka Emmanuel Adegbosin; Victor Adekanmbi; Olatunji O. Adetokunboh; Daniel Adedayo Adeyinka; Bright Opoku Ahinkorah; Keivan Ahmadi; Muktar Beshir Ahmed; Yonas Akalu; Oluwaseun Oladapo Akinyemi; Rufus Olusola Akinyemi; Addis Aklilu; Chisom Joyqueenet Akunna; Fares Alahdab; Ziyad Al-Aly; Noore Alam; Alehegn Aderaw Alamneh; Turki M. Alanzi; Biresaw Wassihun Alemu; Robert Kaba Alhassan; Tilahun Ali; Vahid Alipour; Saeed Amini; Robert Ancuceanu; Fereshteh Ansari; Zelalem Alamrew Anteneh; Davood Anvari; Razique Anwer; Seth Christopher Yaw Appiah; Jalal Arabloo; Mulusew A. Asemahagn; Mohammad Asghari Jafarabadi; Wondwossen Niguse Asmare; Desta Debalkie Atnafu; Maha Moh'd Wahbi Atout; Alok Atreya; Marcel Ausloos; Atalel Fentahun Awedew; Beatriz Paulina Ayala Quintanilla; Martin Amogre Ayanore; Yared Asmare Aynalem; Muluken Altaye Ayza; Samad Azari; Zelalem Nigussie Azene; Zaheer-Ud-Din Babar; Atif Amin Baig; Senthilkumar Balakrishnan; Maciej Banach; Till Winfried Barnighausen; Sanjay Basu; Mohsen Bayati; Neeraj Bedi; Tariku Tesfaye Bekuma; Woldesellassie M Mequanint Bezabhe; Akshaya Srikanth Bhagavathula; Pankaj Bhardwaj; Krittika Bhattacharyya; Zulfiqar A. Bhutta; Sadia Bibi; Boris Bikbov; Tsegaye Adane Birhan; Zebenay Workneh Bitew; Moses John Bockarie; Archith Boloor; Oliver J. Brady; Nicola Luigi Bragazzi; Andrey Nikolaevich Briko; Nikolay Ivanovich Briko; Sharath Burugina Nagaraja; Zahid A. Butt; Rosario Cardenas; Felix Carvalho; Jaykaran Charan; Souranshu Chatterjee; Soosanna Kumary Chattu; Vijay Kumar Chattu; Mohiuddin Ahsanul Kabir Chowdhury; Dinh-Toi Chu; Aubrey J. Cook; Natalie Maria Cormier; Richard G. Cowden; Carlos Culquichicon; Baye Dagnew; Saad M. A. Dahlawi; Giovanni Damiani; Parnaz Daneshpajouhnejad; Farah Daoud; Ahmad Daryani; Jose das Neves; Nicole Davis Weaver; Meseret Derbew Molla; Kebede Deribe; Abebaw Alemayehu Desta; Keshab Deuba; Samath Dhamminda Dharmaratne; Govinda Prasad Dhungana; Daniel Diaz; Shirin Djalalinia; Paul Narh Doku; Eleonora Dubljanin; Bereket Duko; Arielle Wilder Eagan; Lucas Earl; Jeffrey W. Eaton; Andem Effiong; Maysaa El Sayed Zaki; Maha El Tantawi; Rajesh Elayedath; Shaimaa I. El-Jaafary; Aisha Elsharkawy; Sharareh Eskandarieh; Oghenowede Eyawo; Sayeh Ezzikouri; Abidemi Omolara Fasanmi; Alebachew Fasil; Nelsensius Klau Fauk; Valery L. Feigin; Tomas Y. Ferede; Eduarda Fernandes; Florian Fischer; Nataliya A. Foigt; Morenike Oluwatoyin Folayan; Masoud Foroutan; Joel Msafiri Francis; Takeshi Fukumoto; Mohamed M. Gad; Biniyam Sahiledengle Geberemariyam; Birhan Gebresillassie Gebregiorgis; Berhe Gebremichael; Hailay Abrha Gesesew; Lemma Getacher; Keyghobad Ghadiri; Ahmad Ghashghaee; Syed Amir Gilani; Themba G. Ginindza; Mustefa Glagn Glagn; Mahaveer Golechha; Philimon N. Gona; Mohammed Ibrahim Mohialdeen Gubari; Harish Chander Gugnani; Davide Guido; Rashid Abdi Guled; Brian J. Hall; Samer Hamidi; Demelash Woldeyohannes Handiso; Arief Hargono; Abdiwahab Hashi; Soheil Hassanipour; Hadi Hassankhani; Khezar Hayat; Claudiu Herteliu; Hagos Degefa de Hidru; Ramesh Holla; H. Dean Hosgood; Naznin Hossain; Mostafa Hosseini; Mehdi Hosseinzadeh; Mowafa Househ; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Seyed Sina Naghibi Irvani; Chidozie C. D. Iwu; Chinwe Juliana Iwu; Ihoghosa Osamuyi Iyamu; Vardhmaan Jain; Mihajlo Jakovljevic; Farzad Jalilian; Ravi Prakash Jha; Kimberly B. Johnson; Vasna Joshua; Farahnaz Joukar; Jacek Jerzy Jozwiak; Ali Kabir; Leila R. Kalankesh; Rohollah Kalhor; Ashwin Kamath; Naser Kamyari; Tanuj Kanchan; Behzad Karami Matin; Andre Karch; Salah Eddin Karimi; Ayele Semachew Kasa; Getinet Kassahun; Gbenga A. Kayode; Ali Kazemi Karyani; Peter Njenga Keiyoro; Bayew Kelkay; Nauman Khalid; Gulfaraz Khan; Junaid Khan; Md Nuruzzaman Khan; Khaled Khatab; Salman Khazaei; Yun Jin Kim; Adnan Kisa; Sezer Kisa; Sonali Kochhar; Jacek A. Kopec; Soewarta Kosen; Sindhura Lakshmi Koulmane Laxminarayana; Ai Koyanagi; Kewal Krishan; Barthelemy Kuate Defo; Nuworza Kugbey; Vaman Kulkarni; Manasi Kumar; Nithin Kumar; Om P. Kurmi; Dian Kusuma; Desmond Kuupiel; Hmwe Hmwe Kyu; Carlo La Vecchia; Dharmesh Kumar Lal; Jennifer O. Lam; Ivan Landires; Savita Lasrado; Jeffrey V. Lazarus; Alice Lazzar-Atwood; Paul H. Lee; Cheru Tesema Leshargie; Bingyu Li; Xuefeng Liu; Platon D. Lopukhov; Hawraz Ibrahim M. Amin; Deepak Madi; Phetole Walter Mahasha; Azeem Majeed; Afshin Maleki; Shokofeh Maleki; Abdullah A. Mamun; Navid Manafi; Mohammad Ali Mansournia; Francisco Rogerlandio Martins-Melo; Seyedeh Zahra Masoumi; Benjamin K. Mayala; Birhanu Geta Meharie; Hailemariam Abiy Alemu Meheretu; Hagazi Gebre Meles; Mulugeta Melku; Walter Mendoza; Endalkachew Worku Mengesha; T.J. Meretoja; Abera M. Mersha; Tomislav Mestrovic; Ted R. Miller; Andreea Mirica; Mehdi Mirzaei-Alavijeh; Osama Mohamad; Yousef Mohammad; Abdollah Mohammadian-Hafshejani; Jemal Abdu Mohammed; Salahuddin Mohammed; Shafiu Mohammed; Ali H. Mokdad; Taklu Marama Mokonnon; Mariam Molokhia; Masoud Moradi; Yousef Moradi; Rahmatollah Moradzadeh; Paula Moraga; Jonathan F. Mosser; Sandra B. Munro; Ghulam Mustafa; Saravanan Muthupandian; Mehdi Naderi; Ahamarshan Jayaraman Nagarajan; Mohsen Naghavi; Muhammad Naveed; Vinod C. Nayak; Javad Nazari; Rawlance Ndejjo; Samata Nepal; Henok Biresaw Netsere; Frida N. Ngalesoni; Georges Nguefack-Tsague; Josephine W. Ngunjiri; Yeshambel T. Nigatu; Samuel Negash Nigussie; Chukwudi A. Nnaji; Jean Jacques Noubiap; Virginia Nunez-Samudio; Bogdan Oancea; Oluwakemi Ololade Odukoya; Felix Akpojene Ogbo; null et al.

doi:10.1016/S2352-3018(21)00051-5

Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study

Benn Sartorius, John D. VanderHeide, Mingyou Yang, Erik A. Goosmann, Julia Hon, Emily Haeuser, Michael A. Cork, Samantha Perkins, Deepa Jahagirdar, Lauren E. Schaeffer, Audrey L. Serfes, Kate E. LeGrand, Hedayat Abbastabar, Zeleke Hailemariam Abebo, Akine Eshete Abosetugn, Eman Abu-Gharbieh, Manfred Mario Kokou Accrombessi, Oladimeji M. Adebayo, Adeyinka Emmanuel Adegbosin, Victor AdekanmbiOlatunji O. Adetokunboh, Daniel Adedayo Adeyinka, Bright Opoku Ahinkorah, Keivan Ahmadi, Muktar Beshir Ahmed, Yonas Akalu, Oluwaseun Oladapo Akinyemi, Rufus Olusola Akinyemi, Addis Aklilu, Chisom Joyqueenet Akunna, Fares Alahdab, Ziyad Al-Aly, Noore Alam, Alehegn Aderaw Alamneh, Turki M. Alanzi, Biresaw Wassihun Alemu, Robert Kaba Alhassan, Tilahun Ali, Vahid Alipour, Saeed Amini, Robert Ancuceanu, Fereshteh Ansari, Zelalem Alamrew Anteneh, Davood Anvari, Razique Anwer, Seth Christopher Yaw Appiah, Jalal Arabloo, Mulusew A. Asemahagn, Mohammad Asghari Jafarabadi, Wondwossen Niguse Asmare, Desta Debalkie Atnafu, Maha Moh'd Wahbi Atout, Alok Atreya, Marcel Ausloos, Atalel Fentahun Awedew, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Yared Asmare Aynalem, Muluken Altaye Ayza, Samad Azari, Zelalem Nigussie Azene, Zaheer-Ud-Din Babar, Atif Amin Baig, Senthilkumar Balakrishnan, Maciej Banach, Till Winfried Barnighausen, Sanjay Basu, Mohsen Bayati, Neeraj Bedi, Tariku Tesfaye Bekuma, Woldesellassie M Mequanint Bezabhe, Akshaya Srikanth Bhagavathula, Pankaj Bhardwaj, Krittika Bhattacharyya, Zulfiqar A. Bhutta, Sadia Bibi, Boris Bikbov, Tsegaye Adane Birhan, Zebenay Workneh Bitew, Moses John Bockarie, Archith Boloor, Oliver J. Brady, Nicola Luigi Bragazzi, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Sharath Burugina Nagaraja, Zahid A. Butt, Rosario Cardenas, Felix Carvalho, Jaykaran Charan, Souranshu Chatterjee, Soosanna Kumary Chattu, Vijay Kumar Chattu, Mohiuddin Ahsanul Kabir Chowdhury, Dinh-Toi Chu, Aubrey J. Cook, Natalie Maria Cormier, Richard G. Cowden, Carlos Culquichicon, Baye Dagnew, Saad M. A. Dahlawi, Giovanni Damiani, Parnaz Daneshpajouhnejad, Farah Daoud, Ahmad Daryani, Jose das Neves, Nicole Davis Weaver, Meseret Derbew Molla, Kebede Deribe, Abebaw Alemayehu Desta, Keshab Deuba, Samath Dhamminda Dharmaratne, Govinda Prasad Dhungana, Daniel Diaz, Shirin Djalalinia, Paul Narh Doku, Eleonora Dubljanin, Bereket Duko, Arielle Wilder Eagan, Lucas Earl, Jeffrey W. Eaton, Andem Effiong, Maysaa El Sayed Zaki, Maha El Tantawi, Rajesh Elayedath, Shaimaa I. El-Jaafary, Aisha Elsharkawy, Sharareh Eskandarieh, Oghenowede Eyawo, Sayeh Ezzikouri, Abidemi Omolara Fasanmi, Alebachew Fasil, Nelsensius Klau Fauk, Valery L. Feigin, Tomas Y. Ferede, Eduarda Fernandes, Florian Fischer, Nataliya A. Foigt, Morenike Oluwatoyin Folayan, Masoud Foroutan, Joel Msafiri Francis, Takeshi Fukumoto, Mohamed M. Gad, Biniyam Sahiledengle Geberemariyam, Birhan Gebresillassie Gebregiorgis, Berhe Gebremichael, Hailay Abrha Gesesew, Lemma Getacher, Keyghobad Ghadiri, Ahmad Ghashghaee, Syed Amir Gilani, Themba G. Ginindza, Mustefa Glagn Glagn, Mahaveer Golechha, Philimon N. Gona, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Davide Guido, Rashid Abdi Guled, Brian J. Hall, Samer Hamidi, Demelash Woldeyohannes Handiso, Arief Hargono, Abdiwahab Hashi, Soheil Hassanipour, Hadi Hassankhani, Khezar Hayat, Claudiu Herteliu, Hagos Degefa de Hidru, Ramesh Holla, H. Dean Hosgood, Naznin Hossain, Mostafa Hosseini, Mehdi Hosseinzadeh, Mowafa Househ, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M. Ilic, Milena D. Ilic, Seyed Sina Naghibi Irvani, Chidozie C. D. Iwu, Chinwe Juliana Iwu, Ihoghosa Osamuyi Iyamu, Vardhmaan Jain, Mihajlo Jakovljevic, Farzad Jalilian, Ravi Prakash Jha, Kimberly B. Johnson, Vasna Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak, Ali Kabir, Leila R. Kalankesh, Rohollah Kalhor, Ashwin Kamath, Naser Kamyari, Tanuj Kanchan, Behzad Karami Matin, Andre Karch, Salah Eddin Karimi, Ayele Semachew Kasa, Getinet Kassahun, Gbenga A. Kayode, Ali Kazemi Karyani, Peter Njenga Keiyoro, Bayew Kelkay, Nauman Khalid, Gulfaraz Khan, Junaid Khan, Md Nuruzzaman Khan, Khaled Khatab, Salman Khazaei, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Sonali Kochhar, Jacek A. Kopec, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, Nuworza Kugbey, Vaman Kulkarni, Manasi Kumar, Nithin Kumar, Om P. Kurmi, Dian Kusuma, Desmond Kuupiel, Hmwe Hmwe Kyu, Carlo La Vecchia, Dharmesh Kumar Lal, Jennifer O. Lam, Ivan Landires, Savita Lasrado, Jeffrey V. Lazarus, Alice Lazzar-Atwood, Paul H. Lee, Cheru Tesema Leshargie, Bingyu Li, Xuefeng Liu, Platon D. Lopukhov, Hawraz Ibrahim M. Amin, Deepak Madi, Phetole Walter Mahasha, Azeem Majeed, Afshin Maleki, Shokofeh Maleki, Abdullah A. Mamun, Navid Manafi, Mohammad Ali Mansournia, Francisco Rogerlandio Martins-Melo, Seyedeh Zahra Masoumi, Benjamin K. Mayala, Birhanu Geta Meharie, Hailemariam Abiy Alemu Meheretu, Hagazi Gebre Meles, Mulugeta Melku, Walter Mendoza, Endalkachew Worku Mengesha, T.J. Meretoja, Abera M. Mersha, Tomislav Mestrovic, Ted R. Miller, Andreea Mirica, Mehdi Mirzaei-Alavijeh, Osama Mohamad, Yousef Mohammad, Abdollah Mohammadian-Hafshejani, Jemal Abdu Mohammed, Salahuddin Mohammed, Shafiu Mohammed, Ali H. Mokdad, Taklu Marama Mokonnon, Mariam Molokhia, Masoud Moradi, Yousef Moradi, Rahmatollah Moradzadeh, Paula Moraga, Jonathan F. Mosser, Sandra B. Munro, Ghulam Mustafa, Saravanan Muthupandian, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Mohsen Naghavi, Muhammad Naveed, Vinod C. Nayak, Javad Nazari, Rawlance Ndejjo, Samata Nepal, Henok Biresaw Netsere, Frida N. Ngalesoni, Georges Nguefack-Tsague, Josephine W. Ngunjiri, Yeshambel T. Nigatu, Samuel Negash Nigussie, Chukwudi A. Nnaji, Jean Jacques Noubiap, Virginia Nunez-Samudio, Bogdan Oancea, Oluwakemi Ololade Odukoya, Felix Akpojene Ogbo, et al.

Western Sydney University

Research output: Contribution to journal › Article › peer-review

33 Citations (Scopus)

Abstract

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 Ã‚Â·8 (95% uncertainty interval 2Ã‚Â·1-3Ã‚Â·8) in Mauritania to 1585Ã‚Â·9 (1369Ã‚Â·4-1824Ã‚Â·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0Ã‚Â·8 (0Ã‚Â·7-0Ã‚Â·9) in Mauritania to 676Ã‚Â· 5 (513Ã‚Â· 6-888Ã‚Â·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, GuijÃƒÂ¡ District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661Ã‚Â·7 [2544Ã‚Â·8-8120Ã‚Â·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163Ã‚Â·0 [679Ã‚Â·0-1866Ã‚Â·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 [81Ã‚Â· 1%] of 4087 units) and number of deaths (3325 [81Ã‚Â·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.

Original language	English
Pages (from-to)	e363-e375
Number of pages	13
Journal	The Lancet HIV
Volume	8
Issue number	6
DOIs	https://doi.org/10.1016/S2352-3018(21)00051-5
Publication status	Published - 2021

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10.1016/S2352-3018(21)00051-5

Cite this

Sartorius, B., VanderHeide, J. D., Yang, M., Goosmann, E. A., Hon, J., Haeuser, E., Cork, M. A., Perkins, S., Jahagirdar, D., Schaeffer, L. E., Serfes, A. L., LeGrand, K. E., Abbastabar, H., Abebo, Z. H., Abosetugn, A. E., Abu-Gharbieh, E., Accrombessi, M. M. K., Adebayo, O. M., Adegbosin, A. E., ... et al. (2021). Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study. The Lancet HIV, 8(6), e363-e375. https://doi.org/10.1016/S2352-3018(21)00051-5

@article{98dde0f2b61c475f94661b181a23977f,

title = "Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study",

abstract = "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 {\~A}‚{\^A}·8 (95% uncertainty interval 2{\~A}‚{\^A}·1-3{\~A}‚{\^A}·8) in Mauritania to 1585{\~A}‚{\^A}·9 (1369{\~A}‚{\^A}·4-1824{\~A}‚{\^A}·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0{\~A}‚{\^A}·8 (0{\~A}‚{\^A}·7-0{\~A}‚{\^A}·9) in Mauritania to 676{\~A}‚{\^A}· 5 (513{\~A}‚{\^A}· 6-888{\~A}‚{\^A}·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, Guij{\~A}ƒ{\^A}¡ District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661{\~A}‚{\^A}·7 [2544{\~A}‚{\^A}·8-8120{\~A}‚{\^A}·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163{\~A}‚{\^A}·0 [679{\~A}‚{\^A}·0-1866{\~A}‚{\^A}·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{\~A}‚{\^A}· 1%] of 4087 units) and number of deaths (3325 [81{\~A}‚{\^A}·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.",

author = "Benn Sartorius and VanderHeide, {John D.} and Mingyou Yang and Goosmann, {Erik A.} and Julia Hon and Emily Haeuser and Cork, {Michael A.} and Samantha Perkins and Deepa Jahagirdar and Schaeffer, {Lauren E.} and Serfes, {Audrey L.} and LeGrand, {Kate E.} and Hedayat Abbastabar and Abebo, {Zeleke Hailemariam} and Abosetugn, {Akine Eshete} and Eman Abu-Gharbieh and Accrombessi, {Manfred Mario Kokou} and Adebayo, {Oladimeji M.} and Adegbosin, {Adeyinka Emmanuel} and Victor Adekanmbi and Adetokunboh, {Olatunji O.} and Adeyinka, {Daniel Adedayo} and Ahinkorah, {Bright Opoku} and Keivan Ahmadi and Ahmed, {Muktar Beshir} and Yonas Akalu and Akinyemi, {Oluwaseun Oladapo} and Akinyemi, {Rufus Olusola} and Addis Aklilu and Akunna, {Chisom Joyqueenet} and Fares Alahdab and Ziyad Al-Aly and Noore Alam and Alamneh, {Alehegn Aderaw} and Alanzi, {Turki M.} and Alemu, {Biresaw Wassihun} and Alhassan, {Robert Kaba} and Tilahun Ali and Vahid Alipour and Saeed Amini and Robert Ancuceanu and Fereshteh Ansari and Anteneh, {Zelalem Alamrew} and Davood Anvari and Razique Anwer and Appiah, {Seth Christopher Yaw} and Jalal Arabloo and Asemahagn, {Mulusew A.} and Jafarabadi, {Mohammad Asghari} and Asmare, {Wondwossen Niguse} and Atnafu, {Desta Debalkie} and Atout, {Maha Moh'd Wahbi} and Alok Atreya and Marcel Ausloos and Awedew, {Atalel Fentahun} and Quintanilla, {Beatriz Paulina Ayala} and Ayanore, {Martin Amogre} and Aynalem, {Yared Asmare} and Ayza, {Muluken Altaye} and Samad Azari and Azene, {Zelalem Nigussie} and Zaheer-Ud-Din Babar and Baig, {Atif Amin} and Senthilkumar Balakrishnan and Maciej Banach and Barnighausen, {Till Winfried} and Sanjay Basu and Mohsen Bayati and Neeraj Bedi and Bekuma, {Tariku Tesfaye} and Bezabhe, {Woldesellassie M Mequanint} and Bhagavathula, {Akshaya Srikanth} and Pankaj Bhardwaj and Krittika Bhattacharyya and Bhutta, {Zulfiqar A.} and Sadia Bibi and Boris Bikbov and Birhan, {Tsegaye Adane} and Bitew, {Zebenay Workneh} and Bockarie, {Moses John} and Archith Boloor and Brady, {Oliver J.} and Bragazzi, {Nicola Luigi} and Briko, {Andrey Nikolaevich} and Briko, {Nikolay Ivanovich} and Nagaraja, {Sharath Burugina} and Butt, {Zahid A.} and Rosario Cardenas and Felix Carvalho and Jaykaran Charan and Souranshu Chatterjee and Chattu, {Soosanna Kumary} and Chattu, {Vijay Kumar} and Chowdhury, {Mohiuddin Ahsanul Kabir} and Dinh-Toi Chu and Cook, {Aubrey J.} and Cormier, {Natalie Maria} and Cowden, {Richard G.} and Carlos Culquichicon and Baye Dagnew and Dahlawi, {Saad M. A.} and Giovanni Damiani and Parnaz Daneshpajouhnejad and Farah Daoud and Ahmad Daryani and {das Neves}, Jose and Weaver, {Nicole Davis} and Molla, {Meseret Derbew} and Kebede Deribe and Desta, {Abebaw Alemayehu} and Keshab Deuba and Dharmaratne, {Samath Dhamminda} and Dhungana, {Govinda Prasad} and Daniel Diaz and Shirin Djalalinia and Doku, {Paul Narh} and Eleonora Dubljanin and Bereket Duko and Eagan, {Arielle Wilder} and Lucas Earl and Eaton, {Jeffrey W.} and Andem Effiong and Zaki, {Maysaa El Sayed} and Tantawi, {Maha El} and Rajesh Elayedath and El-Jaafary, {Shaimaa I.} and Aisha Elsharkawy and Sharareh Eskandarieh and Oghenowede Eyawo and Sayeh Ezzikouri and Fasanmi, {Abidemi Omolara} and Alebachew Fasil and Fauk, {Nelsensius Klau} and Feigin, {Valery L.} and Ferede, {Tomas Y.} and Eduarda Fernandes and Florian Fischer and Foigt, {Nataliya A.} and Folayan, {Morenike Oluwatoyin} and Masoud Foroutan and Francis, {Joel Msafiri} and Takeshi Fukumoto and Gad, {Mohamed M.} and Geberemariyam, {Biniyam Sahiledengle} and Gebregiorgis, {Birhan Gebresillassie} and Berhe Gebremichael and Gesesew, {Hailay Abrha} and Lemma Getacher and Keyghobad Ghadiri and Ahmad Ghashghaee and Gilani, {Syed Amir} and Ginindza, {Themba G.} and Glagn, {Mustefa Glagn} and Mahaveer Golechha and Gona, {Philimon N.} and Gubari, {Mohammed Ibrahim Mohialdeen} and Gugnani, {Harish Chander} and Davide Guido and Guled, {Rashid Abdi} and Hall, {Brian J.} and Samer Hamidi and Handiso, {Demelash Woldeyohannes} and Arief Hargono and Abdiwahab Hashi and Soheil Hassanipour and Hadi Hassankhani and Khezar Hayat and Claudiu Herteliu and Hidru, {Hagos Degefa de} and Ramesh Holla and Hosgood, {H. Dean} and Naznin Hossain and Mostafa Hosseini and Mehdi Hosseinzadeh and Mowafa Househ and Bing-Fang Hwang and Ibitoye, {Segun Emmanuel} and Ilesanmi, {Olayinka Stephen} and Ilic, {Irena M.} and Ilic, {Milena D.} and Irvani, {Seyed Sina Naghibi} and Iwu, {Chidozie C. D.} and Iwu, {Chinwe Juliana} and Iyamu, {Ihoghosa Osamuyi} and Vardhmaan Jain and Mihajlo Jakovljevic and Farzad Jalilian and Jha, {Ravi Prakash} and Johnson, {Kimberly B.} and Vasna Joshua and Farahnaz Joukar and Jozwiak, {Jacek Jerzy} and Ali Kabir and Kalankesh, {Leila R.} and Rohollah Kalhor and Ashwin Kamath and Naser Kamyari and Tanuj Kanchan and Matin, {Behzad Karami} and Andre Karch and Karimi, {Salah Eddin} and Kasa, {Ayele Semachew} and Getinet Kassahun and Kayode, {Gbenga A.} and Karyani, {Ali Kazemi} and Keiyoro, {Peter Njenga} and Bayew Kelkay and Nauman Khalid and Gulfaraz Khan and Junaid Khan and Khan, {Md Nuruzzaman} and Khaled Khatab and Salman Khazaei and Kim, {Yun Jin} and Adnan Kisa and Sezer Kisa and Sonali Kochhar and Kopec, {Jacek A.} and Soewarta Kosen and Laxminarayana, {Sindhura Lakshmi Koulmane} and Ai Koyanagi and Kewal Krishan and Defo, {Barthelemy Kuate} and Nuworza Kugbey and Vaman Kulkarni and Manasi Kumar and Nithin Kumar and Kurmi, {Om P.} and Dian Kusuma and Desmond Kuupiel and Kyu, {Hmwe Hmwe} and {La Vecchia}, Carlo and Lal, {Dharmesh Kumar} and Lam, {Jennifer O.} and Ivan Landires and Savita Lasrado and Lazarus, {Jeffrey V.} and Alice Lazzar-Atwood and Lee, {Paul H.} and Leshargie, {Cheru Tesema} and Bingyu Li and Xuefeng Liu and Lopukhov, {Platon D.} and Amin, {Hawraz Ibrahim M.} and Deepak Madi and Mahasha, {Phetole Walter} and Azeem Majeed and Afshin Maleki and Shokofeh Maleki and Mamun, {Abdullah A.} and Navid Manafi and Mansournia, {Mohammad Ali} and Martins-Melo, {Francisco Rogerlandio} and Masoumi, {Seyedeh Zahra} and Mayala, {Benjamin K.} and Meharie, {Birhanu Geta} and Meheretu, {Hailemariam Abiy Alemu} and Meles, {Hagazi Gebre} and Mulugeta Melku and Walter Mendoza and Mengesha, {Endalkachew Worku} and T.J. Meretoja and Mersha, {Abera M.} and Tomislav Mestrovic and Miller, {Ted R.} and Andreea Mirica and Mehdi Mirzaei-Alavijeh and Osama Mohamad and Yousef Mohammad and Abdollah Mohammadian-Hafshejani and Mohammed, {Jemal Abdu} and Salahuddin Mohammed and Shafiu Mohammed and Mokdad, {Ali H.} and Mokonnon, {Taklu Marama} and Mariam Molokhia and Masoud Moradi and Yousef Moradi and Rahmatollah Moradzadeh and Paula Moraga and Mosser, {Jonathan F.} and Munro, {Sandra B.} and Ghulam Mustafa and Saravanan Muthupandian and Mehdi Naderi and Nagarajan, {Ahamarshan Jayaraman} and Mohsen Naghavi and Muhammad Naveed and Nayak, {Vinod C.} and Javad Nazari and Rawlance Ndejjo and Samata Nepal and Netsere, {Henok Biresaw} and Ngalesoni, {Frida N.} and Georges Nguefack-Tsague and Ngunjiri, {Josephine W.} and Nigatu, {Yeshambel T.} and Nigussie, {Samuel Negash} and Nnaji, {Chukwudi A.} and Noubiap, {Jean Jacques} and Virginia Nunez-Samudio and Bogdan Oancea and Odukoya, {Oluwakemi Ololade} and Ogbo, {Felix Akpojene} and {et al.}",

year = "2021",

doi = "10.1016/S2352-3018(21)00051-5",

language = "English",

volume = "8",

pages = "e363--e375",

journal = "The Lancet HIV",

issn = "2352-3018",

publisher = "Elsevier Ltd.",

number = "6",

}

Sartorius, B, VanderHeide, JD, Yang, M, Goosmann, EA, Hon, J, Haeuser, E, Cork, MA, Perkins, S, Jahagirdar, D, Schaeffer, LE, Serfes, AL, LeGrand, KE, Abbastabar, H, Abebo, ZH, Abosetugn, AE, Abu-Gharbieh, E, Accrombessi, MMK, Adebayo, OM, Adegbosin, AE, Adekanmbi, V, Adetokunboh, OO, Adeyinka, DA, Ahinkorah, BO, Ahmadi, K, Ahmed, MB, Akalu, Y, Akinyemi, OO, Akinyemi, RO, Aklilu, A, Akunna, CJ, Alahdab, F, Al-Aly, Z, Alam, N, Alamneh, AA, Alanzi, TM, Alemu, BW, Alhassan, RK, Ali, T, Alipour, V, Amini, S, Ancuceanu, R, Ansari, F, Anteneh, ZA, Anvari, D, Anwer, R, Appiah, SCY, Arabloo, J, Asemahagn, MA, Jafarabadi, MA, Asmare, WN, Atnafu, DD, Atout, MMW, Atreya, A, Ausloos, M, Awedew, AF, Quintanilla, BPA, Ayanore, MA, Aynalem, YA, Ayza, MA, Azari, S, Azene, ZN, Babar, Z-U-D, Baig, AA, Balakrishnan, S, Banach, M, Barnighausen, TW, Basu, S, Bayati, M, Bedi, N, Bekuma, TT, Bezabhe, WMM, Bhagavathula, AS, Bhardwaj, P, Bhattacharyya, K, Bhutta, ZA, Bibi, S, Bikbov, B, Birhan, TA, Bitew, ZW, Bockarie, MJ, Boloor, A, Brady, OJ, Bragazzi, NL, Briko, AN, Briko, NI, Nagaraja, SB, Butt, ZA, Cardenas, R, Carvalho, F, Charan, J, Chatterjee, S, Chattu, SK, Chattu, VK, Chowdhury, MAK, Chu, D-T, Cook, AJ, Cormier, NM, Cowden, RG, Culquichicon, C, Dagnew, B, Dahlawi, SMA, Damiani, G, Daneshpajouhnejad, P, Daoud, F, Daryani, A, das Neves, J, Weaver, ND, Molla, MD, Deribe, K, Desta, AA, Deuba, K, Dharmaratne, SD, Dhungana, GP, Diaz, D, Djalalinia, S, Doku, PN, Dubljanin, E, Duko, B, Eagan, AW, Earl, L, Eaton, JW, Effiong, A, Zaki, MES, Tantawi, ME, Elayedath, R, El-Jaafary, SI, Elsharkawy, A, Eskandarieh, S, Eyawo, O, Ezzikouri, S, Fasanmi, AO, Fasil, A, Fauk, NK, Feigin, VL, Ferede, TY, Fernandes, E, Fischer, F, Foigt, NA, Folayan, MO, Foroutan, M, Francis, JM, Fukumoto, T, Gad, MM, Geberemariyam, BS, Gebregiorgis, BG, Gebremichael, B, Gesesew, HA, Getacher, L, Ghadiri, K, Ghashghaee, A, Gilani, SA, Ginindza, TG, Glagn, MG, Golechha, M, Gona, PN, Gubari, MIM, Gugnani, HC, Guido, D, Guled, RA, Hall, BJ, Hamidi, S, Handiso, DW, Hargono, A, Hashi, A, Hassanipour, S, Hassankhani, H, Hayat, K, Herteliu, C, Hidru, HDD, Holla, R, Hosgood, HD, Hossain, N, Hosseini, M, Hosseinzadeh, M, Househ, M, Hwang, B-F, Ibitoye, SE, Ilesanmi, OS, Ilic, IM, Ilic, MD, Irvani, SSN, Iwu, CCD, Iwu, CJ, Iyamu, IO, Jain, V, Jakovljevic, M, Jalilian, F, Jha, RP, Johnson, KB, Joshua, V, Joukar, F, Jozwiak, JJ, Kabir, A, Kalankesh, LR, Kalhor, R, Kamath, A, Kamyari, N, Kanchan, T, Matin, BK, Karch, A, Karimi, SE, Kasa, AS, Kassahun, G, Kayode, GA, Karyani, AK, Keiyoro, PN, Kelkay, B, Khalid, N, Khan, G, Khan, J, Khan, MN, Khatab, K, Khazaei, S, Kim, YJ, Kisa, A, Kisa, S, Kochhar, S, Kopec, JA, Kosen, S, Laxminarayana, SLK, Koyanagi, A, Krishan, K, Defo, BK, Kugbey, N, Kulkarni, V, Kumar, M, Kumar, N, Kurmi, OP, Kusuma, D, Kuupiel, D, Kyu, HH, La Vecchia, C, Lal, DK, Lam, JO, Landires, I, Lasrado, S, Lazarus, JV, Lazzar-Atwood, A, Lee, PH, Leshargie, CT, Li, B, Liu, X, Lopukhov, PD, Amin, HIM, Madi, D, Mahasha, PW, Majeed, A, Maleki, A, Maleki, S, Mamun, AA, Manafi, N, Mansournia, MA, Martins-Melo, FR, Masoumi, SZ, Mayala, BK, Meharie, BG, Meheretu, HAA, Meles, HG, Melku, M, Mendoza, W, Mengesha, EW, Meretoja, TJ, Mersha, AM, Mestrovic, T, Miller, TR, Mirica, A, Mirzaei-Alavijeh, M, Mohamad, O, Mohammad, Y, Mohammadian-Hafshejani, A, Mohammed, JA, Mohammed, S, Mohammed, S, Mokdad, AH, Mokonnon, TM, Molokhia, M, Moradi, M, Moradi, Y, Moradzadeh, R, Moraga, P, Mosser, JF, Munro, SB, Mustafa, G, Muthupandian, S, Naderi, M, Nagarajan, AJ, Naghavi, M, Naveed, M, Nayak, VC, Nazari, J, Ndejjo, R, Nepal, S, Netsere, HB, Ngalesoni, FN, Nguefack-Tsague, G, Ngunjiri, JW, Nigatu, YT, Nigussie, SN, Nnaji, CA, Noubiap, JJ, Nunez-Samudio, V, Oancea, B, Odukoya, OO, Ogbo, FA & et al. 2021, 'Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study', The Lancet HIV, vol. 8, no. 6, pp. e363-e375. https://doi.org/10.1016/S2352-3018(21)00051-5

TY - JOUR

T1 - Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study

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 - Jafarabadi, Mohammad Asghari

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 - Quintanilla, Beatriz Paulina Ayala

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 - Barnighausen, 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 - Nagaraja, Sharath Burugina

AU - Butt, Zahid A.

AU - Cardenas, 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, Jose

AU - Weaver, Nicole Davis

AU - Molla, Meseret Derbew

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 - Zaki, Maysaa El Sayed

AU - Tantawi, Maha El

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 Glagn

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 - Hidru, Hagos Degefa de

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 - Matin, Behzad Karami

AU - Karch, Andre

AU - Karimi, Salah Eddin

AU - Kasa, Ayele Semachew

AU - Kassahun, Getinet

AU - Kayode, Gbenga A.

AU - Karyani, Ali Kazemi

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 - Laxminarayana, Sindhura Lakshmi Koulmane

AU - Koyanagi, Ai

AU - Krishan, Kewal

AU - Defo, Barthelemy Kuate

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, Ivan

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 - Maleki, Shokofeh

AU - Mamun, Abdullah A.

AU - Manafi, Navid

AU - Mansournia, Mohammad Ali

AU - Martins-Melo, Francisco Rogerlandio

AU - Masoumi, Seyedeh Zahra

AU - Mayala, Benjamin K.

AU - Meharie, Birhanu Geta

AU - Meheretu, Hailemariam Abiy Alemu

AU - Meles, Hagazi Gebre

AU - Melku, Mulugeta

AU - Mendoza, Walter

AU - Mengesha, Endalkachew Worku

AU - Meretoja, T.J.

AU - Mersha, Abera M.

AU - Mestrovic, Tomislav

AU - Miller, Ted R.

AU - Mirica, Andreea

AU - Mirzaei-Alavijeh, Mehdi

AU - Mohamad, Osama

AU - Mohammad, Yousef

AU - Mohammadian-Hafshejani, Abdollah

AU - Mohammed, Jemal Abdu

AU - Mohammed, Salahuddin

AU - Mohammed, Shafiu

AU - Mokdad, Ali H.

AU - Mokonnon, Taklu Marama

AU - Molokhia, Mariam

AU - Moradi, Masoud

AU - Moradi, Yousef

AU - Moradzadeh, Rahmatollah

AU - Moraga, Paula

AU - Mosser, Jonathan F.

AU - Munro, Sandra B.

AU - Mustafa, Ghulam

AU - Muthupandian, Saravanan

AU - Naderi, Mehdi

AU - Nagarajan, Ahamarshan Jayaraman

AU - Naghavi, Mohsen

AU - Naveed, Muhammad

AU - Nayak, Vinod C.

AU - Nazari, Javad

AU - Ndejjo, Rawlance

AU - Nepal, Samata

AU - Netsere, Henok Biresaw

AU - Ngalesoni, Frida N.

AU - Nguefack-Tsague, Georges

AU - Ngunjiri, Josephine W.

AU - Nigatu, Yeshambel T.

AU - Nigussie, Samuel Negash

AU - Nnaji, Chukwudi A.

AU - Noubiap, Jean Jacques

AU - Nunez-Samudio, Virginia

AU - Oancea, Bogdan

AU - Odukoya, Oluwakemi Ololade

AU - Ogbo, Felix Akpojene

AU - et al., null

PY - 2021

Y1 - 2021

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 Ã‚Â·8 (95% uncertainty interval 2Ã‚Â·1-3Ã‚Â·8) in Mauritania to 1585Ã‚Â·9 (1369Ã‚Â·4-1824Ã‚Â·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0Ã‚Â·8 (0Ã‚Â·7-0Ã‚Â·9) in Mauritania to 676Ã‚Â· 5 (513Ã‚Â· 6-888Ã‚Â·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, GuijÃƒÂ¡ District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661Ã‚Â·7 [2544Ã‚Â·8-8120Ã‚Â·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163Ã‚Â·0 [679Ã‚Â·0-1866Ã‚Â·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 [81Ã‚Â· 1%] of 4087 units) and number of deaths (3325 [81Ã‚Â·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.

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 Ã‚Â·8 (95% uncertainty interval 2Ã‚Â·1-3Ã‚Â·8) in Mauritania to 1585Ã‚Â·9 (1369Ã‚Â·4-1824Ã‚Â·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0Ã‚Â·8 (0Ã‚Â·7-0Ã‚Â·9) in Mauritania to 676Ã‚Â· 5 (513Ã‚Â· 6-888Ã‚Â·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, GuijÃƒÂ¡ District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661Ã‚Â·7 [2544Ã‚Â·8-8120Ã‚Â·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163Ã‚Â·0 [679Ã‚Â·0-1866Ã‚Â·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 [81Ã‚Â· 1%] of 4087 units) and number of deaths (3325 [81Ã‚Â·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.

UR - https://hdl.handle.net/1959.7/uws:63581

U2 - 10.1016/S2352-3018(21)00051-5

DO - 10.1016/S2352-3018(21)00051-5

M3 - Article

SN - 2352-3018

VL - 8

SP - e363-e375

JO - The Lancet HIV

JF - The Lancet HIV

IS - 6

ER -

Subnational mapping of HIV incidence and mortality among individuals aged 15-49 years in sub-Saharan Africa, 2000-18 : a modelling study

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