Decreasing Adult Prevalence of Advanced HIV Disease From 2 Population-Based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe, 2015–2023

West C.A.; Mungai E.; Birhanu S.; Laws R.; Agyemang E.; Godfrey C.; Stafford K.; Mahlalela K.; Li M.; Pasipamire M.; Philip N.M.; Motebang M.; Sachathep K.K.; Wilson B.; Kalata N.; Bateganya M.; Mbunda A.; Sumba S.; Njau P.F.; Kirungi W.; Gianetti B.; Biraro S.; Mugisha V.; Sivile S.; Mutukwa J.; Mweebo K.; Kancheya N.G.; Auld A.; Mugurungi O.; Peterson A.; Malaba R.; Maphosa T.; Suthar A.B.; Farley S.; Ussery F.; Bronson M.A.; Brown K.H.; Patel H.K.; Justman J.E.; Voetsch A.C. · Open Forum Infectious Diseases (2026) · DOI: 10.1093/ofid/ofaf753

Resumen

Background Limited population data exist assessing trends in advanced HIV disease (AHD) in the test-and-treat era. We examined changes in AHD prevalence from 2015 to 2017 (round 1) and 2019 to 2023 (round 2) in 7 African countries. Methods We pooled data from 2 rounds of the Population-Based HIV Impact Assessment (PHIA) surveys from 7 countries among persons with HIV (PWH) aged 15 to 59 years. AHD was defined as having an HIV-positive result and CD4 <200 cells/mm3. Awareness of HIV diagnosis and treatment status were based on self-report and detection of antiretrovirals. Weighted estimates between survey rounds were compared through complex survey methods. Results Across all countries, 13.2% and 6.8% of PWH met criteria for AHD during rounds 1 and 2, respectively. AHD prevalence among those aware of their HIV status and not on antiretroviral therapy (ART) increased by 31.7% (20.8% to 27.4%) but decreased by 17.7% (17.5% to 14.4%) among those unaware and not on ART and by 53.3% (10.5% to 4.9%) among those aware and on ART. The adjusted odds ratio for AHD comparing rounds 1 and 2 among those aware and on ART was 0.46 (95% CI, 0.39–0.53). Those who were aware and on ART accounted for the majority of PWH with AHD in both rounds (51.6%, round 1; 58.8%, round 2). Conclusions These findings indicate substantial reductions in AHD prevalence among those on ART between 2015–2017 and 2019–2023. Continued efforts are warranted to ensure timely diagnoses and treatment adherence and reduce barriers to care reengagement, which represent an increasingly important driver of AHD. © Published by Oxford University Press on behalf of Infectious Diseases Society of America 2025.