Allorant Adrien, Kuchukhidze Salome, Stannah James, Xia Yiqing, Masuku Sanele S, Ekanmian Gatien K, Imai-Eaton Jeffrey W, Maheu-Giroux Mathieu
Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Int AIDS Soc. 2025 Aug;28(8):e70024. doi: 10.1002/jia2.70024.
INTRODUCTION: Socio-demographic and geographic disparities in HIV prevalence, uptake of HIV testing and access to antiretroviral therapy (ART) persist in high HIV burden countries. Understanding demographic, spatial and temporal factors can guide interventions. METHODS: We analysed 108 geo-referenced population-based surveys conducted over 2000-2023 across 33 African countries, involving 2.3 million respondents. Multilevel Bayesian logistic regression models assessed associations between HIV outcomes (HIV prevalence, recent HIV testing and ART coverage) and socio-demographic characteristics (age, education, place of residence, relative wealth), geographic location (country, district) and time trends. Separate models were estimated for men and women in central, eastern, southern and western Africa. RESULTS: Inequalities in HIV risk and access to testing and treatment services were driven by differences in educational attainment and within-country variations. In southern Africa, women with tertiary education had a 12%-point lower HIV prevalence (95% Credible Interval [CrI]: -27% to -2%) than those with less than primary education. In eastern Africa, they had a 13%-points (95% CrI: 2-22%) higher probability of recent HIV testing. Associations with relative wealth were weaker and more heterogeneous: in southern Africa, HIV prevalence shifted over time from higher to lower wealth quintiles, and adolescent girls and young women became the most frequently tested age group. In central Africa, wealthier men maintained higher recent testing and ART coverage levels. District-level variations accounted for disparities in HIV outcomes. In western Africa, the expected difference in ART coverage between individuals with similar socio-demographic characteristics living in different districts was 14%-points (95% CrI: 3-32%) for men and 10%-points (95% CrI: 3-27%) for women. CONCLUSIONS: Disparities in HIV outcomes are strongly associated with differences in education, and across districts of the same country. Higher education levels are associated with lower HIV prevalence, greater testing and higher ART coverage, while districts with limited services sustain higher population viraemia. Despite the scale-up of HIV prevention and treatment programmes, important disparities remain, and renewed education-centred and geographically targeted efforts are needed to close gaps.
引言：在艾滋病病毒负担较重的国家，艾滋病病毒流行率、艾滋病病毒检测接受情况及获得抗逆转录病毒治疗（ART）方面的社会人口和地理差异依然存在。了解人口、空间和时间因素可为干预措施提供指导。 方法：我们分析了2000年至2023年期间在33个非洲国家开展的108项基于人群的地理定位调查，涉及230万受访者。多水平贝叶斯逻辑回归模型评估了艾滋病病毒相关结果（艾滋病病毒流行率、近期艾滋病病毒检测情况和ART覆盖率）与社会人口特征（年龄、教育程度、居住地点、相对财富）、地理位置（国家、地区）及时间趋势之间的关联。针对非洲中部、东部、南部和西部的男性和女性分别估计了独立模型。 结果：艾滋病病毒感染风险以及检测和治疗服务可及性方面的不平等是由教育程度差异和国内差异导致的。在南部非洲，受过高等教育的女性艾滋病病毒流行率比未接受过小学教育的女性低12个百分点（95%可信区间[CrI]：-27%至-2%）。在东部非洲，她们近期进行艾滋病病毒检测的概率高13个百分点（95% CrI：2%至22%）。与相对财富的关联较弱且更为多样：在南部非洲，艾滋病病毒流行率随时间推移从较高财富五分位数向较低财富五分位数转变，青春期女孩和年轻女性成为检测频率最高的年龄组。在中部非洲，较富裕的男性近期检测率和ART覆盖率维持在较高水平。地区层面的差异导致了艾滋病病毒相关结果的差异。在西部非洲，社会人口特征相似但居住在不同地区的个体之间，男性ART覆盖率的预期差异为14个百分点（95% CrI：3%至32%），女性为10个百分点（95% CrI：3%至27%）。 结论：艾滋病病毒相关结果的差异与教育差异以及同一国家不同地区的差异密切相关。较高的教育水平与较低的艾滋病病毒流行率、更高的检测率和更高的ART覆盖率相关，而服务有限的地区人群病毒血症水平更高。尽管扩大了艾滋病病毒预防和治疗项目，但重要差异依然存在，需要重新以教育为中心并进行地理定位的努力来缩小差距。
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