{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T16:09:06Z","timestamp":1785859746179,"version":"3.56.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"1","funder":[{"DOI":"10.13039\/100009054","name":"US PEPFAR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"US Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U2GGH000994"],"award-info":[{"award-number":["U2GGH000994"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"US Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U2GGH001226"],"award-info":[{"award-number":["U2GGH001226"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"US Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U2GGH002173"],"award-info":[{"award-number":["U2GGH002173"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"US Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU2GGH001271"],"award-info":[{"award-number":["NU2GGH001271"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"US Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U2GGH002172"],"award-info":[{"award-number":["U2GGH002172"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 &amp;lt;200\u2005cells\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20130.53). 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings indicate substantial reductions in AHD prevalence among those on ART between 2015\u20132017 and 2019\u20132023. 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofaf753","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T12:58:02Z","timestamp":1765285082000},"source":"Crossref","is-referenced-by-count":1,"title":["Decreasing Adult Prevalence of Advanced HIV Disease From 2 Population-Based HIV Impact Assessments in Eswatini, Lesotho, Malawi, Tanzania, Uganda, Zambia, and Zimbabwe, 2015\u20132023"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1102-9602","authenticated-orcid":false,"given":"Christine A","family":"West","sequence":"first","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Mungai","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1006-4772","authenticated-orcid":false,"given":"Sehin","family":"Birhanu","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8249-5999","authenticated-orcid":false,"given":"Rebecca","family":"Laws","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elfriede","family":"Agyemang","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5797-7950","authenticated-orcid":false,"given":"Catherine","family":"Godfrey","sequence":"additional","affiliation":[{"name":"Department of Defense, Walter Reed Army Institute of Research , Kampala ,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-6436","authenticated-orcid":false,"given":"Kristen","family":"Stafford","sequence":"additional","affiliation":[{"name":"Center for International Health, Education, and Biosecurity, Institute of Human Virology, School of Medicine, University of Maryland , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khophozile","family":"Mahlalela","sequence":"additional","affiliation":[{"name":"National AIDS Program, Ministry of Health , Mbabane, Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3431-584X","authenticated-orcid":false,"given":"Michelle","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7409-6995","authenticated-orcid":false,"given":"Munyaradzi","family":"Pasipamire","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Mbabane, 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,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0783-1312","authenticated-orcid":false,"given":"Andrew C","family":"Voetsch","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"2026011205412255300_ofaf753-B1","volume-title":"Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017","author":"World Health Organization","year":"2017"},{"key":"2026011205412255300_ofaf753-B2","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1056\/NEJMp2313777","article-title":"Advanced HIV as a neglected disease","volume":"390","author":"Ford","year":"2024","journal-title":"N Engl J 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