{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:16:36Z","timestamp":1791958596790,"version":"4.3.4"},"reference-count":36,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K01AI125086"],"award-info":[{"award-number":["K01AI125086"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI120938"],"award-info":[{"award-number":["R01AI120938"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01AI128779"],"award-info":[{"award-number":["R01AI128779"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>UNAIDS models suggest HIV incidence is declining in sub\u2010Saharan Africa. The objective of this study was to assess whether modelled trends are supported by empirical evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta\u2010analysis of adult HIV incidence data from sub\u2010Saharan Africa by searching Embase, Scopus, PubMed and OVID databases and technical reports published between 1 January 2010 and 23 July 2019. We included prospective and cross\u2010sectional studies that directly measured incidence from blood samples. Incidence data were abstracted according to population risk group, geographic location, sex, intervention arm and calendar period. Weighted regression models were used to assess incidence trends across general population studies by sex. We also identified studies reporting greater than or equal to three incidence measurements since 2010 and assessed trends within them.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total 291 studies, including 22 sub\u2010Saharan African countries, met inclusion criteria. Most studies were conducted in South Africa (\n                      <jats:italic>n<\/jats:italic>\n                      = 102), Uganda (\n                      <jats:italic>n<\/jats:italic>\n                      = 46) and Kenya (\n                      <jats:italic>n<\/jats:italic>\n                      = 41); there were 26 countries with no published incidence data, most in western and central Africa. Data were most commonly derived from prospective observational studies (\n                      <jats:italic>n<\/jats:italic>\n                      = 163; 56%) and from geographically defined populations with limited demographic or risk\u2010based enrolment criteria other than age (i.e., general population studies;\n                      <jats:italic>n<\/jats:italic>\n                      = 151; 52%). Across general population studies, average annual incidence declines since 2010 were 0.12\/100\u00a0person\u2010years (95% CI: 0.06\u20130.18;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001) among men and 0.10\/100\u00a0person\u2010years (95% CI: \u22120.02\u20130.22;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.093) among women in eastern Africa, and 0.25\/100\u00a0person\u2010years (95% CI: 0.17\u2013034;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) among men and 0.42\/100\u00a0person\u2010years (95% CI: 0.23\u20130.62;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0002) among women in southern Africa. In nine of 10 studies with multiple measurements, incidence declined over time, including in two studies of key populations. Across all population risk groups, the highest HIV incidence estimates were observed among men who have sex with men, with rates ranging from 1.0 to 15.4\/100\u00a0person\u2010years. Within general population studies, incidence was typically higher in women than men with a median female\u2010to\u2010male incidence rate ratio of 1.47 (IQR: 1.11 to 1.83) with evidence of a growing sex disparity over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Empirical incidence data show the rate of new HIV infections is declining in eastern and southern Africa. However, recent incidence data are non\u2010existent or very limited for many countries and key populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25818","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T09:45:48Z","timestamp":1634809548000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["Declining HIV incidence in sub\u2010Saharan Africa: a systematic review and meta\u2010analysis of empiric data"],"prefix":"10.1002","volume":"24","author":[{"given":"Keya","family":"Joshi","sequence":"first","affiliation":[{"name":"Department of Epidemiology Harvard TH Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Lessler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8954-6426","authenticated-orcid":false,"given":"Oluwasolape","family":"Olawore","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Loevinsohn","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophrena","family":"Bushey","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron A R","family":"Tobian","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"Department of Pathology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4451-3436","authenticated-orcid":false,"given":"M Kate","family":"Grabowski","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"Department of Pathology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"2020 Global AIDS Update \u2010 Seizing the Moment \u2060\u2010 Tackling Entrenched Inequalities to End Epidemics [Internet]. 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