Adult HIV-1 incidence across 15 high-burden countries in sub-Saharan Africa from 2015 to 2019: a pooled analysis of nationally representative data

Nora E. Rosenberg, Bonnie E. Shook-Sa, Mincen Liu, Lynda Stranix-Chibanda, Marcel Yotebieng, Nadia A. Sam-Agudu, Michael G. Hudgens, Sam J. Phiri, Wilbroad Mutale, Linda Gail Bekker, Sizulu Moyo, Khangelani Zuma, Manhattan E. Charurat, Jessica Justman, Benjamin H. Chi

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)e175-e185
JournalThe Lancet HIV
Issue number3
StatePublished - Mar 2023
Externally publishedYes

Bibliographical note

Funding Information:
This analysis and NER, ML, BES-S, MGH, and BHC were funded by the NIH (R21-MH125705) with investigator support (P30-AI050410, K24-AI120796, 5U2G-GH001226). NAIIS was supported by PEPFAR through the CDC under the Cooperative Agreement #U2GGH002108 to the University of Maryland, Baltimore, and by the Global Fund to Fight AIDS, Tuberculosis and Malaria through the National Agency for the Control of AIDS, Nigeria, under the contract #NGA-H-NACA to the University of Maryland, Baltimore. SABSSM was supported by PEPFAR through the CDC Cooperative Agreement #NU2GGH001629. The PHIAs were supported by PEPFAR through the CDC under the terms of cooperative agreement #U2GGH001226 and U2GGH000994 to ICAP Columbia. We thank the study teams and participants across all surveys.

Funding Information:
LS-C received funding from ViiV Healthcare to support travel to an adolescents and HIV workshop in 2022. MY received grant funding and an honorarium payment from the National Institutes of Health (NIH). NAS-A received funding from the NIH and a grant from ViiV Healthcare. JJ served on the Roche Diagnostics Scientific Advisory Board in April 2022. BHC received a consulting fee from UNICEF. All other authors declare no competing interests.

Publisher Copyright:
© 2023 Elsevier Ltd

PubMed: MeSH publication types

  • Meta-Analysis
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.


Dive into the research topics of 'Adult HIV-1 incidence across 15 high-burden countries in sub-Saharan Africa from 2015 to 2019: a pooled analysis of nationally representative data'. Together they form a unique fingerprint.

Cite this