title: Recent HIV prevalence trends among pregnant women and all women in sub-Saharan Africa: implications for HIV estimates.
abstract: OBJECTIVE
  National population-wide HIV prevalence and incidence trends in sub-Saharan Africa (SSA) are indirectly estimated using HIV prevalence measured among pregnant women attending antenatal clinics (ANC), among other data. We evaluated whether recent HIV prevalence trends among pregnant women are representative of general population trends.
  
  
  METHODS
  Serial population-based household surveys in 13 SSA countries.
  
  
  METHODS
  We calculated HIV prevalence trends among all women aged 15-49 years and currently pregnant women between surveys conducted from 2003 to 2008 (period 1) and 2009 to 2012 (period 2). Log-binomial regression was used to test for a difference in prevalence trend between the two groups. Prevalence among pregnant women was age-standardized to represent the age distribution of all women.
  
  
  RESULTS
  Pooling data for all countries, HIV prevalence declined among pregnant women from 6.5 [95% confidence interval (CI) 5.3-7.9%] to 5.3% (95% CI 4.2-6.6%) between periods 1 and 2, whereas it remained unchanged among all women at 8.4% (95% CI 8.0-8.9%) in period 1 and 8.3% (95% CI 7.9-8.8%) in period 2. Prevalence declined by 18% (95% CI -9-38%) more in pregnant women than nonpregnant women. Estimates were similar in Western, Eastern, and Southern regions of SSA; none were statistically significant (P>0.05). HIV prevalence decreased significantly among women aged 15-24 years while increasing significantly among women 35-49 years, who represented 29% of women but only 15% of pregnant women. Age-standardization of prevalence in pregnant women did not reconcile the discrepant trends because at older ages prevalence was lower among pregnant women than nonpregnant women.
  
  
  CONCLUSIONS
  As HIV prevalence in SSA has shifted toward older, less-fertile women, HIV prevalence among pregnant women has declined more rapidly than prevalence in women overall. Interpretation of ANC prevalence data to inform national HIV estimates should account for both age-specific fertility patterns and HIV-related sub-fertility.
authors.affiliation: aDepartment of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom bHuman Sciences Research Council cCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa dMinistry of Health, Government of the Kingdom of Swaziland, Mbabane, Swaziland eCenters for Disease Control and Prevention Kenya, Nairobi, Kenya fStrategic Information and Evidence Department, UNAIDS, Geneva, Switzerland.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Eaton
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Rehle
authors.forename: Sean
authors.initials: S
authors.lastname: Jooste
authors.forename: Rejoice
authors.initials: R
authors.lastname: Nkambule
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
authors.forename: Mary
authors.initials: M
authors.lastname: Mahy
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Hallett
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D017677:Age Distribution; D004812:Epidemiologic Methods; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011295:Prenatal Care; D015995:Prevalence; D055815:Young Adult