Abstract Body

Countries with a higher prevalence of HIV (at least 5% infected) have been prioritized in PEPFAR and Global Fund sponsored antiretroviral treatment programmes.  However 50% of HIV-infected people live in countries with lower HIV prevalence (<5% infected).  The aim was to compare uptake of HIV testing and treatment in adults and children between countries with higher or lower HIV prevalence.

The UNAIDS 2015 database includes country-level information on epidemic size, prevalence of HIV infection, antiretroviral treatment coverage, Antenatal Clinic (ANC) visits and Early Infant Diagnosis (EID).  The analysis included results from 52 low and middle income countries with at least 50,000 people infected with HIV included.  Least squares linear regression was used to correlate national adult HIV prevalence HIV with estimated rates of treatment coverage (adults, pregnant women and children), ANC, and EID.  The analysis was weighted by epidemic size and controlled for GDP/capita and region (African vs non-African countries).

Of the 52 low or middle income countries in this analysis, 40 had a lower prevalence of HIV <5% (total 16 million HIV infections), while 12 had a prevalence of at least 5% (total 16.1 million HIV infections).  As shown in the summary Table, the lower prevalence countries had significantly lower rates of treatment coverage in adults, pregnant women and children (p<0.01 for each comparison).  In addition, lower prevalence countries had a smaller percentage of women attending antenatal clinic visits and Early Infant Diagnosis (EID) for infants (p<0.01). The annual death rate for people with HIV was 4.5% in the lower prevalence countries versus 2.5% in the higher prevalence countries.  The HIV transmission rate (total new infections divided by HIV epidemic size) was 6.2% in lower prevalence countries versus 5.4% in higher prevalence countries. 

In this analysis of the UNAIDS 2015 database, including 32.1 million HIV infected people in 52 low or middle income countries, lower prevalence countries had significantly lower treatment coverage in adults, pregnant women and children, lower rates of Antenatal Clinic Visits and Early Infant Detection, and higher annual death rates.  Countries with lower HIV prevalence need to upscale HIV and testing and treatment further, to meet the UNAIDS 90-90-90 targets by 2020.