Tracking the Tide of HIV in Middle-Aged Adults in East and South Africa: Insights from AWI-Gen Longitudinal Study

Francesc Xavier Gomez-Olive, University of the Witwatersrand
Luicer A. Ingasia Olubayo, Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Theophilous Mathema, Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Chodziwadziwa Kabudula, University of the Witwatersrand
Lisa K. Micklesfield, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Shukri Mohamed, African Population and Health Research Center (APHRC)
Isaac Kisiangani, African Population and Health Research Center (APHRC)
Cairo B. Ntimana, Dikgale Mamabolo Mothiba (DIMAMO) Population Health Research Centre, University of Limpopo, Polokwane, South Africa
Solomon S. Choma, Dikgale Mamabolo Mothiba (DIMAMO) Population Health Research Centre, University of Limpopo, Polokwane, South Africa
Brian Houle, The Australian National University
Scott Hazelhurst, Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Nigel Crowther, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Stephen Tollman, University of the Witwatersrand
Furahini D. Tluway, Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
Michele Ramsay, Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Background: Sub-Saharan Africa population is aging with people aged 50 and older living with HIV. Data on HIV incidence among older adults is limited. Methods: The AWI-Gen longitudinal study examined a community-based random sample of adults aged 40-60 years in Wave-1 (2011-2016) and 40+ years in Wave-2 (2019-2022), selected from centres in Nairobi (Kenya) and Soweto, Agincourt, and DIMAMO (South Africa). We assessed HIV incidence over person-years exposed, prevalence, and ART coverage. Logistic regression analysis was used to identify sociodemographic factors associated with HIV acquisition. Findings: Overall HIV prevalence decreased from 22·2% in Wave-1 to 21·8% in Wave-2. HIV prevalence increased in Kenya (13·9% to 18%) but decreased in South Africa (25·6% to 22·9%). For the combined cohort of 3,342 individuals HIV negative at baseline, 40 seroconverted, resulting in an overall HIV incidence rate of 0·35 per 100 person-years [95% confidence interval (CI): 0·26-0·48]. Self-reported HIV status accuracy improved from 55·5% to 77·0%, and ART uptake increased from 90% to 95%. Conclusion: While ART coverage has improved, HIV prevalence remains high among older adults from East and South Africa. HIV acquisition risk remains noteworthy among this population emphasizing the need for targeted public health interventions to address this age group.

Keywords: Population Ageing, Health and Morbidity, Longitudinal studies

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