Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lancet HIV. 2023 Mar;10(3):e175-e185. doi: 10.1016/S2352-3018(22)00328-9. Epub 2023 Jan 23.
BACKGROUND: Harmonised population-based surveys with recent HIV-1 infection testing algorithms permit pooled cross-sectional estimation of HIV incidence across multiple countries. We aimed to estimate adult HIV-1 incidence rates and number of new infections by sex, age, and subregion in sub-Saharan Africa. METHODS: We analysed data from 13 Population-Based HIV Impact Assessment (PHIA) surveys and two additional population-based surveys done between 2015 and 2019 in 15 sub-Saharan African countries. HIV-seropositive samples from adults aged 15-59 years were tested for recent HIV-1 infection by use of an algorithm consisting of the HIV-1 limiting antigen avidity enzyme immunoassay, HIV-1 viral load, and qualitative detection of antiretroviral agents. Data were pooled across countries; sampling weights were incorporated to represent all adults in the 15 national populations. Analyses accounted for the complex sample designs. HIV incidence rates, incidence rate differences, and number of new annual infections were estimated. FINDINGS: Among 445 979 adults sampled, 382 had recent HIV-1 infection. The estimated HIV-1 incidence rate was 3·3 per 1000 person-years (95% CI 2·6-4·0) among women and 2·0 per 1000 person-years (1·2-2·7) among men (incidence rate difference 1·3 per 1000 person-years, 95% CI 0·3-2·3). Among adults aged 15-24 years, the incidence rate was higher for women (3·5 per 1000 person-years) than men (1·2 per 1000 person-years; difference 2·3, 95% CI 0·8-3·8), but infection rates were similar between sexes in all other age groups. The HIV-1 incidence rate was 7·4 per 1000 person-years (95% CI 5·0-9·7) in southern sub-Saharan Africa, 2·3 per 1000 person-years (1·7-2·9) in the eastern subregion, and 0·9 per 1000 person-years (0·6-1·2) in the western and central subregion. 689 000 (95% CI 546 000-833 000) new HIV cases were estimated annually among the 265 million susceptible adults (61·6% in women). INTERPRETATION: HIV-1 incidence and number of new infections differed by age, sex, and subregion. Approaches for risk stratification are needed to guide comprehensive HIV-1 prevention. FUNDING: National Institutes of Health.
背景：采用基于人群的统一调查和最近的 HIV-1 感染检测算法，可以对多个国家的 HIV 发病率进行汇总的横断面估计。我们旨在估计撒哈拉以南非洲地区成人 HIV-1 发病率以及按性别、年龄和子区域划分的新感染人数。
方法：我们分析了来自撒哈拉以南非洲 15 个国家的 13 项基于人群的 HIV 影响评估（PHIA）调查以及另外两项于 2015 年至 2019 年期间进行的基于人群的调查的数据。从年龄在 15 至 59 岁的成年人中采集的 HIV 阳性样本，采用由 HIV-1 限制抗原亲和力酶免疫测定、HIV-1 病毒载量和抗逆转录病毒药物定性检测组成的算法，检测最近的 HIV-1 感染。对各国的数据进行汇总；采用抽样权重来代表 15 个国家人群中的所有成年人。分析考虑了复杂的样本设计。估计了 HIV 发病率、发病率差异和新的年度感染人数。
发现：在 445979 名抽样成年人中，有 382 人最近感染了 HIV-1。女性的 HIV-1 发病率估计为每 1000 人年 3.3 例（95%CI 2.6-4.0），男性为每 1000 人年 2.0 例（1.2-2.7）（发病率差异为每 1000 人年 1.3 例，95%CI 0.3-2.3）。在 15-24 岁的成年人中，女性的发病率（每 1000 人年 3.5 例）高于男性（每 1000 人年 1.2 例；差异 2.3，95%CI 0.8-3.8），但在所有其他年龄组中，男女之间的感染率相似。在南部撒哈拉以南非洲，HIV-1 发病率为每 1000 人年 7.4 例（95%CI 5.0-9.7），在东部地区为每 1000 人年 2.3 例（1.7-2.9），在西部和中部地区为每 1000 人年 0.9 例（0.6-1.2）。在 2.65 亿易感成年人中，估计每年有 68.9 万（95%CI 54.6 万-83.3 万）例新的 HIV 病例。
解释：HIV-1 发病率和新感染人数因年龄、性别和子区域而异。需要采用风险分层方法来指导全面的 HIV-1 预防。
资助：美国国立卫生研究院。
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