National and regional trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa
Monitoring knowledge of HIV status among people living with HIV (PLHIV) is essential for an effective national HIV response. One of the major health policy objectives of the past decade in the global HIV response has been the adoption of targets to end the AIDS epidemic by 2030. The first of these targets stipulates that 90% of PLHIV should be aware of their status by 2020, and 95% by 2025. Estimating the size of the undiagnosed population, however, is difficult: neither the number who are diagnosed, nor the number of people living with HIV, are directly counted. In this presentation, I will describe a mathematical model of HIV testing behaviors that estimates knowledge of status and other metrics of HIV testing services efficiency. Combining and triangulating more than 183 population-based surveys (2·7 million participants) with national HIV testing program reports (315 country-years) from 40 countries in sub-Saharan Africa, we show remarkable increases in knowledge of status across sub-Saharan Africa over 2000-2020. However, stark sex, age, and regional disparities remain. Concomitant decreases in HIV testing positivity and proportion of new diagnoses among all positive tests highlight one of the major challenges faced by testing programs: targeting of HIV testing services to achieve greatest yield of new diagnoses. This talk will conclude by highlighting current and future methodological challenges, as well as potential solutions to increase the precision and granularity of estimates.
