Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa
The Global AIDS Strategy 2021-2026 identifies adolescent girls and young women (AGYW) as a priority population for HIV prevention, and recommends differentiating intervention portfolios geographically based on local HIV incidence and individual risk behaviours. We estimated prevalence of HIV risk be...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10115274/?tool=EBI |
| _version_ | 1797697420764643328 |
|---|---|
| author | Adam Howes Kathryn A. Risher Van Kính Nguyen Oliver Stevens Katherine M. Jia Timothy M. Wolock Rachel T. Esra Lycias Zembe Ian Wanyeki Mary Mahy Clemens Benedikt Seth R. Flaxman Jeffrey W. Eaton |
| author_facet | Adam Howes Kathryn A. Risher Van Kính Nguyen Oliver Stevens Katherine M. Jia Timothy M. Wolock Rachel T. Esra Lycias Zembe Ian Wanyeki Mary Mahy Clemens Benedikt Seth R. Flaxman Jeffrey W. Eaton |
| author_sort | Adam Howes |
| collection | DOAJ |
| description | The Global AIDS Strategy 2021-2026 identifies adolescent girls and young women (AGYW) as a priority population for HIV prevention, and recommends differentiating intervention portfolios geographically based on local HIV incidence and individual risk behaviours. We estimated prevalence of HIV risk behaviours and associated HIV incidence at health district level among AGYW living in 13 countries in sub-Saharan Africa. We analysed 46 geospatially-referenced national household surveys conducted between 1999-2018 across 13 high HIV burden countries in sub-Saharan Africa. Female survey respondents aged 15-29 years were classified into four risk groups (not sexually active, cohabiting, non-regular or multiple partner[s] and female sex workers [FSW]) based on reported sexual behaviour. We used a Bayesian spatio-temporal multinomial regression model to estimate the proportion of AGYW in each risk group stratified by district, year, and five-year age group. Using subnational estimates of HIV prevalence and incidence produced by countries with support from UNAIDS, we estimated new HIV infections in each risk group by district and age group. We then assessed the efficiency of prioritising interventions according to risk group. Data consisted of 274,970 female survey respondents aged 15-29. Among women aged 20-29, cohabiting (63.1%) was more common in eastern Africa than non-regular or multiple partner(s) (21.3%), while in southern countries non-regular or multiple partner(s) (58.9%) were more common than cohabiting (23.4%). Risk group proportions varied substantially across age groups (65.9% of total variation explained), countries (20.9%), and between districts within each country (11.3%), but changed little over time (0.9%). Prioritisation based on behavioural risk, in combination with location- and age-based prioritisation, reduced the proportion of population required to be reached in order to find half of all expected new infections from 19.4% to 10.6%. FSW were 1.3% of the population but 10.6% of all expected new infections. Our risk group estimates provide data for HIV programmes to set targets and implement differentiated prevention strategies outlined in the Global AIDS Strategy. Successfully implementing this approach would result in more efficiently reaching substantially more of those at risk for infections. |
| first_indexed | 2024-03-12T03:40:03Z |
| format | Article |
| id | doaj.art-d069d0f86ee44b149ed446d3ca5e0117 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T03:40:03Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-d069d0f86ee44b149ed446d3ca5e01172023-09-03T13:04:45ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752023-01-0134Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan AfricaAdam HowesKathryn A. RisherVan Kính NguyenOliver StevensKatherine M. JiaTimothy M. WolockRachel T. EsraLycias ZembeIan WanyekiMary MahyClemens BenediktSeth R. FlaxmanJeffrey W. EatonThe Global AIDS Strategy 2021-2026 identifies adolescent girls and young women (AGYW) as a priority population for HIV prevention, and recommends differentiating intervention portfolios geographically based on local HIV incidence and individual risk behaviours. We estimated prevalence of HIV risk behaviours and associated HIV incidence at health district level among AGYW living in 13 countries in sub-Saharan Africa. We analysed 46 geospatially-referenced national household surveys conducted between 1999-2018 across 13 high HIV burden countries in sub-Saharan Africa. Female survey respondents aged 15-29 years were classified into four risk groups (not sexually active, cohabiting, non-regular or multiple partner[s] and female sex workers [FSW]) based on reported sexual behaviour. We used a Bayesian spatio-temporal multinomial regression model to estimate the proportion of AGYW in each risk group stratified by district, year, and five-year age group. Using subnational estimates of HIV prevalence and incidence produced by countries with support from UNAIDS, we estimated new HIV infections in each risk group by district and age group. We then assessed the efficiency of prioritising interventions according to risk group. Data consisted of 274,970 female survey respondents aged 15-29. Among women aged 20-29, cohabiting (63.1%) was more common in eastern Africa than non-regular or multiple partner(s) (21.3%), while in southern countries non-regular or multiple partner(s) (58.9%) were more common than cohabiting (23.4%). Risk group proportions varied substantially across age groups (65.9% of total variation explained), countries (20.9%), and between districts within each country (11.3%), but changed little over time (0.9%). Prioritisation based on behavioural risk, in combination with location- and age-based prioritisation, reduced the proportion of population required to be reached in order to find half of all expected new infections from 19.4% to 10.6%. FSW were 1.3% of the population but 10.6% of all expected new infections. Our risk group estimates provide data for HIV programmes to set targets and implement differentiated prevention strategies outlined in the Global AIDS Strategy. Successfully implementing this approach would result in more efficiently reaching substantially more of those at risk for infections.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10115274/?tool=EBI |
| spellingShingle | Adam Howes Kathryn A. Risher Van Kính Nguyen Oliver Stevens Katherine M. Jia Timothy M. Wolock Rachel T. Esra Lycias Zembe Ian Wanyeki Mary Mahy Clemens Benedikt Seth R. Flaxman Jeffrey W. Eaton Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa PLOS Global Public Health |
| title | Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa |
| title_full | Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa |
| title_fullStr | Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa |
| title_full_unstemmed | Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa |
| title_short | Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa |
| title_sort | spatio temporal estimates of hiv risk group proportions for adolescent girls and young women across 13 priority countries in sub saharan africa |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10115274/?tool=EBI |
| work_keys_str_mv | AT adamhowes spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT kathrynarisher spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT vankinhnguyen spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT oliverstevens spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT katherinemjia spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT timothymwolock spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT racheltesra spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT lyciaszembe spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT ianwanyeki spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT marymahy spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT clemensbenedikt spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT sethrflaxman spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica AT jeffreyweaton spatiotemporalestimatesofhivriskgroupproportionsforadolescentgirlsandyoungwomenacross13prioritycountriesinsubsaharanafrica |