OA02.03

Progress toward HIV elimination goals: trends in and projections of treatment as prevention strategy in 38 African countries

Title

Progress toward HIV elimination goals: trends in and projections of treatment as prevention strategy in 38 African countries

Presenter

Phuong Nguyen

Authors

P. Nguyen * (1), S. Gilmour (1), P. Le (1), K. Onishi (1), K. Kato (2), H. Nguyen (1)

Institutions

(1) St. Luke''s International University, Graduate School of Public Health, Japan, (2) Kanto Rosai Hospital, Department of Obstetrics and Gynaecology, Japan

BACKGROUND: We aimed to estimate the trends and projections of indicators of Treatment-as-Prevention (TasP), the key global strategy for HIV elimination in Africa, and to calculate the probability of reaching key UNAIDS targets.
METHODS: We included 1,456,224 sexually active adults age 15-49 in 38 African countries from 112 nationally representative population-based surveys 2003-2018. Bayesian mixed-effect models were applied to estimate the prevalence of annual HIV testing and condom use for every country and year to 2030, and the probability of reaching UNAIDS targets in 2020 and 2030.
RESULTS: Most countries have upward trends in TasP outcomes, but seven saw downward trends in annual HIV testing and five saw decreases in condom use (Figure1). The highest coverage of annual HIV testing in 2030 is predicted in Swaziland with 92.6% (95%CrI: 74.5%-98.1%), Uganda with 90.5% (72.2%-97.2%) and Lesotho with 90.5% (69.4%-97.6%). Meanwhile, Swaziland, Lesotho, and Namibia will have the highest proportion of condom use in 2030 at 85.0% (57.8%-96.1%), 75.6% (42.3%-93.6%), and 75.5% (42.4%-93.2%). The probabilities of reaching targets range from 0% to 28.5% for HIV testing and 0% to 12.1% for condom use and no country showed a high probability (>50%) of meeting either target (Table1).

Table 1: Estimated coverage and annual rate of change (ARC) of annual HIV testing and condom use in 38 African countries, 2003'2030
Country Annually tested for HIV
(95% Credible Interval) Condom used at last sex
(95% Credible Interval)
2003 2010 2020 2030 ARC
(%) % reaching targets* 2003 2010 2020 2030 ARC
(%) % reaching targets*
Angola 49.0
(31.2, 67.8) 61.1
(42.2, 77.1) 76.0
(53.3, 89.5) 86.5
(61.9, 96.2) 4.3
(-0.4, 9.6) 6.0% 9.6
(4.1, 20.8) 11.6
(5.7, 22.4) 14.9
(6.8, 29.6) 18.9
(6.8, 42.3) -0.0
(-4.6, 4.9) 0.0%
Benin 44.1
(27.6, 61.6) 43.2
(27.5, 60.6) 42.2
(24.2, 62.7) 41.1
(19.2, 67.0) -3.2
(-6.8, 0.4) 0.0% 7.4
(3.7, 14.1) 8.2
(4.4, 14.7) 9.5
(4.8, 18.1) 11.0
(4.5, 24.7) -1.3
(-5.3, 2.6) 0.0%
Burkina Faso 45.2
(28.4, 62.7) 48.3
(28.9, 68.1) 52.8
(24.6, 79.1) 57.1
(18.5, 88.9) -1.0
(-6.9, 5.2) 0.3% 11.6
(5.9, 21.2) 13.7
(6.9, 25.2) 17.4
(6.9, 36.9) 21.7
(5.8, 54.2) -0.1
(-5.5, 4.9) 0.0%
Burundi 46.2
(29.4, 63.9) 49.8
(32.3, 67.6) 55.0
(33.4, 75.1) 60.4
(31.6, 83.3) -0.7
(-4.7, 3.4) 0.0% 5.1
(2.2, 10.9) 5.1
(2.5, 9.8) 5.1
(2.3, 10.7) 5.1
(1.7, 14.2) -2.8
(-7.7, 1.7) 0.0%
Cameroon 45.5
(28.8, 63.3) 46.5
(29.6, 64.2) 47.8
(25.8, 70.8) 49.3
(20.3, 78.1) -2.2
(-6.7, 2.3) 0.0% 17.5
(9.4, 30.5) 22.5
(12.8, 36.3) 31.1
(16.4, 51.4) 41.3
(18.0, 70.1) 1.6
(-3.0, 6.5) 0.0%
Central Africa 45.4
(28.0, 63.6) 48.7
(29.3, 68.7) 53.3
(24.3, 80.3) 57.9
(18.0, 89.9) -0.9
(-6.9, 5.5) 0.3% 8.2
(3.8, 16.8) 9.5
(4.4, 19.0) 11.6
(4.3, 27.4) 14.0
(3.5, 41.5) -0.6
(-6.0, 5.0) 0.0%
Chad 47.4
(30.4, 65.1) 54.0
(35.6, 70.9) 63.6
(40.3, 81.9) 71.9
(40.7, 90.6) 1.1
(-3.3, 5.7) 0.2% 4.2
(2.0, 8.2) 3.8
(2.0, 7.3) 3.4
(1.4, 7.8) 3.0
(0.9, 9.6) -4.1
(-9.0, 0.3) 0.0%
Comoros 44.7
(27.8, 63.0) 45.9
(28.0, 64.9) 47.9
(22.5, 74.3) 49.8
(16.3, 83.0) -2.0
(-7.5, 3.5) 0.0% 9.4
(4.2, 19.4) 11.0
(5.2, 21.7) 14.0
(5.6, 30.8) 17.7
(5.0, 46.6) -0.2
(-5.4, 5.2) 0.0%
Congo 42.8
(26.3, 60.6) 41.6
(25.3, 59.5) 40.1
(21.1, 63.0) 38.3
(15.1, 68.5) -3.4
(-7.7, 1.0) 0.0% 14.4
(7.6, 25.8) 18.4
(10.3, 30.6) 25.2
(12.8, 43.1) 33.6
(14.1, 60.9) 1.2
(-3.1, 5.9) 0.0%
Cote d`Ivoire 43.9
(27.6, 61.9) 45.2
(28.5, 63.2) 47.3
(26.5, 69.0) 49.1
(22.4, 76.1) -2.0
(-5.9, 2.2) 0.0% 14.1
(7.3, 25.4) 16.6
(9.1, 27.8) 20.8
(10.6, 36.7) 25.6
(10.3, 50.2) -0.1
(-4.7, 4.1) 0.0%
DR Congo 44.7
(28.1, 62.6) 46.7
(29.6, 64.5) 49.3
(27.0, 72.1) 52.2
(21.9, 80.6) -1.7
(-6.2, 2.9) 0.0% 6.7
(3.3, 13.0) 7.4
(3.9, 13.7) 8.4
(3.8, 17.3) 9.5
(2.9, 25.8) -1.5
(-6.4, 3.3) 0.0%
Ethiopia 46.8
(30.1, 64.3) 54.9
(37.0, 71.4) 65.9
(43.7, 82.8) 75.6
(46.8, 91.4) 1.9
(-2.3, 6.3) 0.2% 5.2
(2.6, 10.2) 5.5
(2.9, 10.3) 5.9
(2.7, 12.3) 6.3
(2.1, 16.7) -2.1
(-6.4, 2.1) 0.0%
Gabon 47.1
(29.7, 65.4) 54.2
(34.6, 72.3) 63.8
(36.5, 84.4) 72.8
(35.0, 93.2) 1.3
(-4.0, 7.1) 0.8% 20.9
(9.9, 39.2) 28.8
(15.4, 47.3) 42.7
(21.3, 67.6) 58.0
(25.1, 86.1) 3.3
(-2.3, 9.9) 0.4%
Gambia 42.5
(25.5, 60.9) 39.2
(23.9, 57.0) 34.3
(18.2, 55.5) 30.0
(12.2, 57.1) -4.7
(-8.5, -0.6) 0.0% 5.4
(2.5, 11.2) 5.9
(3.0, 11.4) 6.8
(2.9, 15.2) 7.7
(2.2, 23.2) -1.5
(-6.5, 4.1) 0.0%
Ghana 41.2
(25.2, 59.4) 39.5
(24.4, 57.3) 36.7
(18.9, 59.6) 34.3
(12.9, 65.2) -3.8
(-8.1, 1.0) 0.0% 11.4
(6.1, 20.6) 12.7
(7.2, 21.5) 14.8
(7.1, 28.3) 17.2
(6.1, 38.1) -1.1
(-5.8, 2.8) 0.0%
Guinea 44.8
(28.6, 62.6) 43.4
(27.5, 60.8) 40.9
(22.7, 62.2) 38.6
(16.7, 65.6) -3.7
(-7.6, 0.0) 0.0% 8.9
(4.5, 16.8) 10.2
(5.6, 17.8) 12.4
(6.3, 23.0) 15.0
(6.3, 32.1) -0.7
(-4.8, 3.3) 0.0%
Kenya 49.0
(31.9, 66.3) 60.9
(42.4, 76.5) 75.7
(52.9, 89.5) 86.1
(60.4, 96.2) 4.2
(-0.5, 9.7) 6.2% 10.9
(5.7, 19.9) 14.6
(8.0, 25.1) 21.4
(10.3, 39.4) 30.5
(11.9, 60.4) 1.9
(-2.2, 6.9) 0.0%
Lesotho 50.6
(32.6, 68.6) 64.6
(45.9, 79.2) 80.6
(60.1, 92.0) 90.5
(69.4, 97.6) 5.6
(0.4, 11.4) 17.5% 22.5
(12.0, 38.3) 34.9
(21.3, 51.3) 56.4
(33.1, 77.8) 75.6
(42.3, 93.6) 6.0
(0.3, 13.2) 3.8%
Liberia 46.1
(29.6, 64.0) 51.2
(32.9, 69.1) 58.5
(32.5, 80.6) 65.3
(28.8, 89.4) 0.1
(-4.9, 5.6) 0.2% 8.8
(4.3, 17.1) 10.4
(5.3, 19.1) 12.8
(5.6, 26.9) 15.7
(4.9, 39.9) -0.5
(-5.4, 4.6) 0.0%
Madagascar 43.3
(27.1, 61.1) 38.1
(22.4, 57.8) 31.2
(12.9, 57.9) 25.0
(5.9, 61.6) -5.7
(-11.2, -0.4) 0.0% 3.6
(1.7, 7.2) 2.9
(1.5, 5.6) 2.2
(0.8, 5.9) 1.6
(0.3, 6.9) -5.7
(-12.0, -0.2) 0.0%
Malawi 47.5
(30.8, 65.0) 55.4
(38.0, 71.8) 66.0
(45.2, 82.1) 75.3
(49.9, 90.4) 1.7
(-2.1, 5.7) 0.1% 9.2
(4.6, 17.1) 12.5
(6.8, 21.6) 18.9
(9.8, 33.6) 27.4
(11.9, 52.3) 2.0
(-1.7, 6.9) 0.0%
Mali 45.1
(28.8, 62.8) 45.1
(28.4, 62.3) 45.5
(25.8, 66.8) 45.8
(20.1, 73.0) -2.6
(-6.7, 1.4) 0.0% 3.7
(1.8, 7.4) 4.1
(2.2, 7.7) 4.7
(2.2, 9.6) 5.3
(1.8, 15.5) -1.5
(-5.8, 3.6) 0.0%
Mozambique 50.6
(32.8, 68.6) 58.3
(40.2, 74.2) 68.8
(46.5, 84.5) 77.3
(48.0, 92.4) 1.7
(-3.3, 6.2) 0.4% 11.4
(6.0, 20.5) 15.3
(8.6, 25.6) 22.8
(11.6, 40.4) 32.4
(14.0, 60.5) 2.0
(-1.9, 6.9) 0.0%
Namibia 49.2
(31.7, 67.3) 61.6
(42.5, 77.5) 76.4
(52.0, 90.7) 86.8
(58.5, 97.0) 4.4
(-1.0, 10.4) 9.1% 32.0
(17.6, 51.2) 43.4
(27.1, 61.3) 60.7
(37.0, 80.3) 75.5
(42.4, 93.2) 4.2
(-1.8, 10.8) 2.7%
Niger 44.3
(27.5, 62.0) 44.8
(27.5, 63.5) 45.8
(21.4, 71.7) 46.9
(14.3, 80.7) -2.4
(-7.8, 3.0) 0.0% 2.2
(1.0, 4.6) 1.8
(0.9, 3.6) 1.4
(0.5, 3.8) 1.0
(0.2, 4.7) -5.5
(-12.0, 0.3) 0.0%
Nigeria 41.0
(24.6, 59.5) 42.2
(26.6, 60.0) 44.2
(25.4, 65.2) 46.1
(21.3, 73.6) -2.0
(-5.9, 2.7) 0.0% 8.3
(4.4, 15.1) 9.8
(5.4, 17.0) 12.2
(6.2, 22.6) 15.0
(6.2, 31.7) -0.4
(-4.2, 3.3) 0.0%
Rwanda 47.7
(30.6, 65.1) 53.8
(35.7, 71.1) 62.5
(39.0, 81.1) 70.3
(38.5, 89.6) 0.8
(-3.7, 5.3) 0.1% 7.1
(3.5, 13.7) 9.7
(5.2, 17.6) 14.9
(7.0, 29.9) 22.3
(8.1, 52.3) 2.0
(-2.2, 8.2) 0.0%
Sao Tome Principe 47.0
(29.9, 64.9) 52.5
(34.1, 70.4) 60.4
(35.9, 80.6) 67.7
(35.1, 89.3) 0.4
(-4.2, 5.3) 0.1% 15.3
(7.5, 28.7) 20.6
(11.3, 34.3) 30.1
(15.3, 51.5) 41.8
(17.7, 72.6) 2.3
(-2.5, 8.0) 0.0%
Senegal 44.9
(28.3, 62.7) 45.7
(29.7, 62.9) 46.5
(28.7, 65.4) 47.3
(25.4, 70.2) -2.4
(-5.6, 0.9) 0.0% 6.5
(3.3, 12.5) 6.9
(3.9, 12.2) 7.4
(3.9, 13.8) 7.9
(3.3, 17.9) -2.1
(-6.0, 1.6) 0.0%
Sierra Leone 43.2
(26.4, 61.6) 38.5
(23.2, 56.2) 31.9
(16.4, 52.8) 26.2
(10.0, 54.0) -5.4
(-9.5, -1.4) 0.0% 5.2
(2.6, 10.4) 5.4
(2.9, 10.2) 5.7
(2.4, 12.4) 6.0
(1.7, 18.3) -2.3
(-7.5, 2.6) 0.0%
South Africa 49.4
(31.6, 68.0) 62.4
(43.6, 78.0) 78.1
(56.6, 90.6) 88.4
(65.5, 96.8) 4.9
(0.0, 10.2) 9.6% 24.2
(10.6, 46.8) 34.2
(18.7, 53.9) 51.5
(30.4, 71.9) 68.4
(38.5, 88.5) 4.3
(-0.9, 10.8) 0.5%
South Sudan 45.0
(27.8, 63.3) 47.5
(27.9, 67.4) 50.7
(22.4, 78.4) 54.4
(15.9, 87.8) -1.4
(-7.5, 4.8) 0.2% 3.2
(1.4, 7.2) 3.0
(1.4, 6.6) 2.7
(0.9, 7.8) 2.4
(0.4, 10.7) -3.9
(-10.3, 2.1) 0.0%
Swaziland 51.1
(33.1, 69.3) 66.4
(48.5, 80.5) 83.2
(64.0, 93.2) 92.6
(74.5, 98.1) 6.6
(1.2, 12.5) 28.5% 37.5
(21.5, 56.7) 51.7
(35.0, 67.5) 71.1
(48.9, 86.4) 85.0
(57.8, 96.1) 5.6
(-0.3, 12.4) 12.1%
Tanzania 49.1
(32.0, 66.5) 57.9
(39.6, 74.2) 69.6
(45.0, 86.5) 79.4
(48.3, 94.1) 2.4
(-2.7, 7.4) 1.3% 12.0
(6.5, 20.8) 13.7
(7.7, 23.0) 16.3
(8.3, 29.7) 19.5
(7.6, 40.3) -0.7
(-5.0, 3.0) 0.0%
Togo 44.1
(27.3, 62.5) 44.8
(27.8, 63.6) 45.4
(23.9, 68.8) 46.3
(18.6, 77.2) -2.5
(-7.0, 2.1) 0.0% 11.8
(5.7, 22.9) 14.4
(7.7, 25.2) 19.1
(9.3, 35.3) 24.8
(8.9, 52.2) 0.5
(-4.5, 5.6) 0.0%
Uganda 49.8
(32.0, 67.9) 64.0
(45.8, 78.5) 80.5
(61.4, 91.2) 90.5
(72.2, 97.2) 5.8
(1.1, 10.8) 15.2% 9.9
(5.0, 18.5) 11.8
(6.4, 20.9) 15.3
(7.5, 28.8) 19.4
(7.5, 42.1) 0.0
(-4.1, 4.4) 0.0%
Zambia 48.9
(31.6, 67.1) 60.7
(42.2, 76.5) 75.4
(52.4, 89.8) 85.9
(59.5, 96.4) 4.2
(-0.9, 9.9) 6.5% 15.3
(7.7, 28.4) 19.4
(10.7, 32.8) 26.8
(13.0, 47.0) 35.9
(13.6, 66.3) 1.3
(-3.6, 6.4) 0.0%
Zimbabwe 47.9
(30.6, 65.5) 59.9
(42.2, 75.1) 75.0
(55.1, 88.0) 85.6
(64.7, 95.1) 4.2
(0.1, 8.9) 3.0% 15.4
(8.0, 27.6) 20.4
(11.7, 32.9) 29.4
(16.3, 47.6) 40.3
(18.9, 66.4) 2.0
(-2.2, 6.8) 0.0%

Figure 1: Trends of coverage in reporting annual HIV testing and condom use from 2003 to 2030 in 38 African countries

CONCLUSIONS: We observed limited progress on TasP in Africa and little prospect of reaching global targets for HIV/AIDS elimination. Varying outcomes in countries at the same development level suggest inadequate resource allocation and low effectiveness of HIV/AIDS programs. Although some funding agencies are considering withdrawal from supporting Africa, more attention to funding and expanding testing and treatment are needed in this region.

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Table 1: Estimated coverage and annual rate of change (ARC) of annual HIV testing and condom use in 38 African countries, 2003'2030
Country	Annually tested for HIV (95% Credible Interval)						Condom used at last sex (95% Credible Interval)
Country	2003	2010	2020	2030	ARC (%)	% reaching targets*	2003	2010	2020	2030	ARC (%)	% reaching targets*
Angola	49.0 (31.2, 67.8)	61.1 (42.2, 77.1)	76.0 (53.3, 89.5)	86.5 (61.9, 96.2)	4.3 (-0.4, 9.6)	6.0%	9.6 (4.1, 20.8)	11.6 (5.7, 22.4)	14.9 (6.8, 29.6)	18.9 (6.8, 42.3)	-0.0 (-4.6, 4.9)	0.0%
Benin	44.1 (27.6, 61.6)	43.2 (27.5, 60.6)	42.2 (24.2, 62.7)	41.1 (19.2, 67.0)	-3.2 (-6.8, 0.4)	0.0%	7.4 (3.7, 14.1)	8.2 (4.4, 14.7)	9.5 (4.8, 18.1)	11.0 (4.5, 24.7)	-1.3 (-5.3, 2.6)	0.0%
Burkina Faso	45.2 (28.4, 62.7)	48.3 (28.9, 68.1)	52.8 (24.6, 79.1)	57.1 (18.5, 88.9)	-1.0 (-6.9, 5.2)	0.3%	11.6 (5.9, 21.2)	13.7 (6.9, 25.2)	17.4 (6.9, 36.9)	21.7 (5.8, 54.2)	-0.1 (-5.5, 4.9)	0.0%
Burundi	46.2 (29.4, 63.9)	49.8 (32.3, 67.6)	55.0 (33.4, 75.1)	60.4 (31.6, 83.3)	-0.7 (-4.7, 3.4)	0.0%	5.1 (2.2, 10.9)	5.1 (2.5, 9.8)	5.1 (2.3, 10.7)	5.1 (1.7, 14.2)	-2.8 (-7.7, 1.7)	0.0%
Cameroon	45.5 (28.8, 63.3)	46.5 (29.6, 64.2)	47.8 (25.8, 70.8)	49.3 (20.3, 78.1)	-2.2 (-6.7, 2.3)	0.0%	17.5 (9.4, 30.5)	22.5 (12.8, 36.3)	31.1 (16.4, 51.4)	41.3 (18.0, 70.1)	1.6 (-3.0, 6.5)	0.0%
Central Africa	45.4 (28.0, 63.6)	48.7 (29.3, 68.7)	53.3 (24.3, 80.3)	57.9 (18.0, 89.9)	-0.9 (-6.9, 5.5)	0.3%	8.2 (3.8, 16.8)	9.5 (4.4, 19.0)	11.6 (4.3, 27.4)	14.0 (3.5, 41.5)	-0.6 (-6.0, 5.0)	0.0%
Chad	47.4 (30.4, 65.1)	54.0 (35.6, 70.9)	63.6 (40.3, 81.9)	71.9 (40.7, 90.6)	1.1 (-3.3, 5.7)	0.2%	4.2 (2.0, 8.2)	3.8 (2.0, 7.3)	3.4 (1.4, 7.8)	3.0 (0.9, 9.6)	-4.1 (-9.0, 0.3)	0.0%
Comoros	44.7 (27.8, 63.0)	45.9 (28.0, 64.9)	47.9 (22.5, 74.3)	49.8 (16.3, 83.0)	-2.0 (-7.5, 3.5)	0.0%	9.4 (4.2, 19.4)	11.0 (5.2, 21.7)	14.0 (5.6, 30.8)	17.7 (5.0, 46.6)	-0.2 (-5.4, 5.2)	0.0%
Congo	42.8 (26.3, 60.6)	41.6 (25.3, 59.5)	40.1 (21.1, 63.0)	38.3 (15.1, 68.5)	-3.4 (-7.7, 1.0)	0.0%	14.4 (7.6, 25.8)	18.4 (10.3, 30.6)	25.2 (12.8, 43.1)	33.6 (14.1, 60.9)	1.2 (-3.1, 5.9)	0.0%
Cote d`Ivoire	43.9 (27.6, 61.9)	45.2 (28.5, 63.2)	47.3 (26.5, 69.0)	49.1 (22.4, 76.1)	-2.0 (-5.9, 2.2)	0.0%	14.1 (7.3, 25.4)	16.6 (9.1, 27.8)	20.8 (10.6, 36.7)	25.6 (10.3, 50.2)	-0.1 (-4.7, 4.1)	0.0%
DR Congo	44.7 (28.1, 62.6)	46.7 (29.6, 64.5)	49.3 (27.0, 72.1)	52.2 (21.9, 80.6)	-1.7 (-6.2, 2.9)	0.0%	6.7 (3.3, 13.0)	7.4 (3.9, 13.7)	8.4 (3.8, 17.3)	9.5 (2.9, 25.8)	-1.5 (-6.4, 3.3)	0.0%
Ethiopia	46.8 (30.1, 64.3)	54.9 (37.0, 71.4)	65.9 (43.7, 82.8)	75.6 (46.8, 91.4)	1.9 (-2.3, 6.3)	0.2%	5.2 (2.6, 10.2)	5.5 (2.9, 10.3)	5.9 (2.7, 12.3)	6.3 (2.1, 16.7)	-2.1 (-6.4, 2.1)	0.0%
Gabon	47.1 (29.7, 65.4)	54.2 (34.6, 72.3)	63.8 (36.5, 84.4)	72.8 (35.0, 93.2)	1.3 (-4.0, 7.1)	0.8%	20.9 (9.9, 39.2)	28.8 (15.4, 47.3)	42.7 (21.3, 67.6)	58.0 (25.1, 86.1)	3.3 (-2.3, 9.9)	0.4%
Gambia	42.5 (25.5, 60.9)	39.2 (23.9, 57.0)	34.3 (18.2, 55.5)	30.0 (12.2, 57.1)	-4.7 (-8.5, -0.6)	0.0%	5.4 (2.5, 11.2)	5.9 (3.0, 11.4)	6.8 (2.9, 15.2)	7.7 (2.2, 23.2)	-1.5 (-6.5, 4.1)	0.0%
Ghana	41.2 (25.2, 59.4)	39.5 (24.4, 57.3)	36.7 (18.9, 59.6)	34.3 (12.9, 65.2)	-3.8 (-8.1, 1.0)	0.0%	11.4 (6.1, 20.6)	12.7 (7.2, 21.5)	14.8 (7.1, 28.3)	17.2 (6.1, 38.1)	-1.1 (-5.8, 2.8)	0.0%
Guinea	44.8 (28.6, 62.6)	43.4 (27.5, 60.8)	40.9 (22.7, 62.2)	38.6 (16.7, 65.6)	-3.7 (-7.6, 0.0)	0.0%	8.9 (4.5, 16.8)	10.2 (5.6, 17.8)	12.4 (6.3, 23.0)	15.0 (6.3, 32.1)	-0.7 (-4.8, 3.3)	0.0%
Kenya	49.0 (31.9, 66.3)	60.9 (42.4, 76.5)	75.7 (52.9, 89.5)	86.1 (60.4, 96.2)	4.2 (-0.5, 9.7)	6.2%	10.9 (5.7, 19.9)	14.6 (8.0, 25.1)	21.4 (10.3, 39.4)	30.5 (11.9, 60.4)	1.9 (-2.2, 6.9)	0.0%
Lesotho	50.6 (32.6, 68.6)	64.6 (45.9, 79.2)	80.6 (60.1, 92.0)	90.5 (69.4, 97.6)	5.6 (0.4, 11.4)	17.5%	22.5 (12.0, 38.3)	34.9 (21.3, 51.3)	56.4 (33.1, 77.8)	75.6 (42.3, 93.6)	6.0 (0.3, 13.2)	3.8%
Liberia	46.1 (29.6, 64.0)	51.2 (32.9, 69.1)	58.5 (32.5, 80.6)	65.3 (28.8, 89.4)	0.1 (-4.9, 5.6)	0.2%	8.8 (4.3, 17.1)	10.4 (5.3, 19.1)	12.8 (5.6, 26.9)	15.7 (4.9, 39.9)	-0.5 (-5.4, 4.6)	0.0%
Madagascar	43.3 (27.1, 61.1)	38.1 (22.4, 57.8)	31.2 (12.9, 57.9)	25.0 (5.9, 61.6)	-5.7 (-11.2, -0.4)	0.0%	3.6 (1.7, 7.2)	2.9 (1.5, 5.6)	2.2 (0.8, 5.9)	1.6 (0.3, 6.9)	-5.7 (-12.0, -0.2)	0.0%
Malawi	47.5 (30.8, 65.0)	55.4 (38.0, 71.8)	66.0 (45.2, 82.1)	75.3 (49.9, 90.4)	1.7 (-2.1, 5.7)	0.1%	9.2 (4.6, 17.1)	12.5 (6.8, 21.6)	18.9 (9.8, 33.6)	27.4 (11.9, 52.3)	2.0 (-1.7, 6.9)	0.0%
Mali	45.1 (28.8, 62.8)	45.1 (28.4, 62.3)	45.5 (25.8, 66.8)	45.8 (20.1, 73.0)	-2.6 (-6.7, 1.4)	0.0%	3.7 (1.8, 7.4)	4.1 (2.2, 7.7)	4.7 (2.2, 9.6)	5.3 (1.8, 15.5)	-1.5 (-5.8, 3.6)	0.0%
Mozambique	50.6 (32.8, 68.6)	58.3 (40.2, 74.2)	68.8 (46.5, 84.5)	77.3 (48.0, 92.4)	1.7 (-3.3, 6.2)	0.4%	11.4 (6.0, 20.5)	15.3 (8.6, 25.6)	22.8 (11.6, 40.4)	32.4 (14.0, 60.5)	2.0 (-1.9, 6.9)	0.0%
Namibia	49.2 (31.7, 67.3)	61.6 (42.5, 77.5)	76.4 (52.0, 90.7)	86.8 (58.5, 97.0)	4.4 (-1.0, 10.4)	9.1%	32.0 (17.6, 51.2)	43.4 (27.1, 61.3)	60.7 (37.0, 80.3)	75.5 (42.4, 93.2)	4.2 (-1.8, 10.8)	2.7%
Niger	44.3 (27.5, 62.0)	44.8 (27.5, 63.5)	45.8 (21.4, 71.7)	46.9 (14.3, 80.7)	-2.4 (-7.8, 3.0)	0.0%	2.2 (1.0, 4.6)	1.8 (0.9, 3.6)	1.4 (0.5, 3.8)	1.0 (0.2, 4.7)	-5.5 (-12.0, 0.3)	0.0%
Nigeria	41.0 (24.6, 59.5)	42.2 (26.6, 60.0)	44.2 (25.4, 65.2)	46.1 (21.3, 73.6)	-2.0 (-5.9, 2.7)	0.0%	8.3 (4.4, 15.1)	9.8 (5.4, 17.0)	12.2 (6.2, 22.6)	15.0 (6.2, 31.7)	-0.4 (-4.2, 3.3)	0.0%
Rwanda	47.7 (30.6, 65.1)	53.8 (35.7, 71.1)	62.5 (39.0, 81.1)	70.3 (38.5, 89.6)	0.8 (-3.7, 5.3)	0.1%	7.1 (3.5, 13.7)	9.7 (5.2, 17.6)	14.9 (7.0, 29.9)	22.3 (8.1, 52.3)	2.0 (-2.2, 8.2)	0.0%
Sao Tome Principe	47.0 (29.9, 64.9)	52.5 (34.1, 70.4)	60.4 (35.9, 80.6)	67.7 (35.1, 89.3)	0.4 (-4.2, 5.3)	0.1%	15.3 (7.5, 28.7)	20.6 (11.3, 34.3)	30.1 (15.3, 51.5)	41.8 (17.7, 72.6)	2.3 (-2.5, 8.0)	0.0%
Senegal	44.9 (28.3, 62.7)	45.7 (29.7, 62.9)	46.5 (28.7, 65.4)	47.3 (25.4, 70.2)	-2.4 (-5.6, 0.9)	0.0%	6.5 (3.3, 12.5)	6.9 (3.9, 12.2)	7.4 (3.9, 13.8)	7.9 (3.3, 17.9)	-2.1 (-6.0, 1.6)	0.0%
Sierra Leone	43.2 (26.4, 61.6)	38.5 (23.2, 56.2)	31.9 (16.4, 52.8)	26.2 (10.0, 54.0)	-5.4 (-9.5, -1.4)	0.0%	5.2 (2.6, 10.4)	5.4 (2.9, 10.2)	5.7 (2.4, 12.4)	6.0 (1.7, 18.3)	-2.3 (-7.5, 2.6)	0.0%
South Africa	49.4 (31.6, 68.0)	62.4 (43.6, 78.0)	78.1 (56.6, 90.6)	88.4 (65.5, 96.8)	4.9 (0.0, 10.2)	9.6%	24.2 (10.6, 46.8)	34.2 (18.7, 53.9)	51.5 (30.4, 71.9)	68.4 (38.5, 88.5)	4.3 (-0.9, 10.8)	0.5%
South Sudan	45.0 (27.8, 63.3)	47.5 (27.9, 67.4)	50.7 (22.4, 78.4)	54.4 (15.9, 87.8)	-1.4 (-7.5, 4.8)	0.2%	3.2 (1.4, 7.2)	3.0 (1.4, 6.6)	2.7 (0.9, 7.8)	2.4 (0.4, 10.7)	-3.9 (-10.3, 2.1)	0.0%
Swaziland	51.1 (33.1, 69.3)	66.4 (48.5, 80.5)	83.2 (64.0, 93.2)	92.6 (74.5, 98.1)	6.6 (1.2, 12.5)	28.5%	37.5 (21.5, 56.7)	51.7 (35.0, 67.5)	71.1 (48.9, 86.4)	85.0 (57.8, 96.1)	5.6 (-0.3, 12.4)	12.1%
Tanzania	49.1 (32.0, 66.5)	57.9 (39.6, 74.2)	69.6 (45.0, 86.5)	79.4 (48.3, 94.1)	2.4 (-2.7, 7.4)	1.3%	12.0 (6.5, 20.8)	13.7 (7.7, 23.0)	16.3 (8.3, 29.7)	19.5 (7.6, 40.3)	-0.7 (-5.0, 3.0)	0.0%
Togo	44.1 (27.3, 62.5)	44.8 (27.8, 63.6)	45.4 (23.9, 68.8)	46.3 (18.6, 77.2)	-2.5 (-7.0, 2.1)	0.0%	11.8 (5.7, 22.9)	14.4 (7.7, 25.2)	19.1 (9.3, 35.3)	24.8 (8.9, 52.2)	0.5 (-4.5, 5.6)	0.0%
Uganda	49.8 (32.0, 67.9)	64.0 (45.8, 78.5)	80.5 (61.4, 91.2)	90.5 (72.2, 97.2)	5.8 (1.1, 10.8)	15.2%	9.9 (5.0, 18.5)	11.8 (6.4, 20.9)	15.3 (7.5, 28.8)	19.4 (7.5, 42.1)	0.0 (-4.1, 4.4)	0.0%
Zambia	48.9 (31.6, 67.1)	60.7 (42.2, 76.5)	75.4 (52.4, 89.8)	85.9 (59.5, 96.4)	4.2 (-0.9, 9.9)	6.5%	15.3 (7.7, 28.4)	19.4 (10.7, 32.8)	26.8 (13.0, 47.0)	35.9 (13.6, 66.3)	1.3 (-3.6, 6.4)	0.0%
Zimbabwe	47.9 (30.6, 65.5)	59.9 (42.2, 75.1)	75.0 (55.1, 88.0)	85.6 (64.7, 95.1)	4.2 (0.1, 8.9)	3.0%	15.4 (8.0, 27.6)	20.4 (11.7, 32.9)	29.4 (16.3, 47.6)	40.3 (18.9, 66.4)	2.0 (-2.2, 6.8)	0.0%