Prevalence and determinants of HIV among reproductive-age women (15-49 years) in Africa from 2010 to 2019: a multilevel analysis of demographic and health survey data.

Background: Human immunodeficiency virus (HIV) remains the leading cause of global morbidity and mortality. The incidence of HIV is disproportionately higher in Sub-Saharan regions, particularly the Southern African sub-region, which is the most affected region and accounts for 77% of all new HIV infections in the region. Thus, the aim of this study was to identify the determinants of HIV among reproductive-age women in Africa.

Methods: This study was conducted among reproductive-age women in Africa, based on secondary data obtained from the Demographic Health Survey (DHS) conducted between 2010 and 2019. The outcome variable was HIV status, while individual- and community-level variables served as potential predictors. The model fit was assessed using Akaike's Information Criterion, Bayesian Information Criterion, and - 2 Log likelihood. Then, multilevel mixed-effects analysis was used. Intra-cluster correlation coefficient, median odds ratio, and proportional change in variance were used to measure heterogeneity between clusters.

Results: A total of 292,810 unweighted and 293,773 weighted reproductive-age women in 26 African nations were included in this study. The overall prevalence of HIV among reproductive-age women in Africa was 4.34% (95% CI: 4.2, 4.4%). The highest percentage of HIV was found in Lesotho (23.98%), followed by South Africa (19.12%), and Mozambique (14.67%). However, the lowest HIV prevalence was found in Niger (0.54%), Senegal (0.59%), and Burundi (0.79%). Southern Africa has the highest HIV burden (18.5%), followed by Eastern Africa (6.1%), while Western African countries have the lowest HIV burden. Increasing maternal age, higher maternal education, women who were unemployed, a history of multiple sexual partners, women in a union, community-level educational status, community-level wealth index, African sub-region, and urban residence were found to be independent predictors of HIV infection in Africa.

Conclusion: The burden of HIV has remained higher, highlighting the need for targeted public health intervention strategies to prevent the transmission of HIV among key populations.