The roll-out of antiretroviral therapy (ART) has changed contexts of HIV risk, but the influence on HIV incidence among young women is not clear. We aimed to summarise direct estimates of HIV incidence among adolescent girls and young women since ART and before large investments in targeted prevention for those in sub-Saharan Africa.
We did a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, Global Health, and CINAHL for studies reporting HIV incidence data from serological samples collected among females aged 15–24 years in ten countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) that were selected for DREAMS investment in 2015. We only included articles published in English. Our main outcome was to summarise recent levels and trends in HIV incidence estimates collected between 2005 and 2015, published or received from study authors, by age and sex, and pooled by region.
51 studies were identified from nine of the ten DREAMS countries; no eligible studies from Lesotho were identified. Directly observed HIV incidence rates were lowest among females aged 13–19 years in Kumi, Uganda (0·38 cases per 100 person-years); and directly observed HIV incidence rates were highest in KwaZulu-Natal, South Africa (7·79 per 100 person-years among females aged 15–19 years, and 8·63 in those aged 20–24 years), among fishing communities in Uganda (12·40 per 100 person-years in females aged 15–19 years and 4·70 in those aged 20–24 years), and among female sex workers aged 18–24 years in South Africa (13·20 per 100 person-years) and Zimbabwe (10·80). In pooled rates from the general population studies, the greatest sex differentials were in the youngest age groups—ie, females aged 15–19 years compared with male peers in both southern African (pooled relative risk 5·94, 95% CI 3·39–10·44) and eastern African countries (3·22, 1·51–6·87), and not significantly different among those aged 25–29 years in either region. Incidence often peaked earlier (during teenage years) among high-risk groups compared with general populations. Since 2005, HIV incidence among adolescent girls and young women declined in Rakai (Uganda) and Manicaland (Zimbabwe), and also declined among female sex workers in Kenya, but not in the highest-risk communities in South Africa and Uganda.
University of Lincoln, College of Social Science Research
Isolde Birdthistle, London School of Hygiene & Tropical Medicine, Department of Population Health,
Clare Tanton, London School of Hygiene & Tropical Medicine, Department of Infectious Disease Epidemiology
Andrew Tomita, Centre for Rural Health, School of Nursing and Public Health, and KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP)
Kristende Graaf, London School of Hygiene & Tropical Medicine, Department of Population Health
Susan BSchaffnit, London School of Hygiene & Tropical Medicine, Department of Population Health
Frank Tanser, Africa Centre Building, Africa Health Research Institute and University of Lincoln, Lincoln Institute for Health
Emma Slaymaker, London School of Hygiene & Tropical Medicine, Department of Population Health,