Estimating age specific prevalence and force of infection in Zimbabwe using combined cross-sectional surveys from 2005 to 2015

Abstract

Objective: Age structured sexual mixing patterns have been noted to be associated with HIV prevalence and force of infection. Therefore, this study aimed to estimate the age dependent HIV force of infection using survey cross-sectional data from Zimbabwe.

Methods: We fit generalized additive models namely; linear, semi-parametric, non-parametric and non-proportional hazards models. Using the 2005–06, 2010–11 and 2015 Zimbabwe Demographic Health Surveys data. The Akaike Information Criteria was used to select the best model. The best model was then used to estimate the age dependent HIV prevalence and force-of-infection.

Results: Based on birth year cohort-specific prevalence, the female HIV prevalence reaches the highest peak at around 29 years of age, then declines thereafter. Males have a lower cohort specific prevalence between 15 and 30 years than females. Male cohort-specific prevalence slightly decreases between the ages of 33 and 39, then peaks around the age of 40. The cohort-specific FOI is greater in females than in males throughout all age categories. In addition, the cohort-specific HIV FOI peaked at ages 22 and 40 for females and males, respectively. The observed 18-year age difference between the HIV FOI peaks of males and females.

Conclusion: Our model was appealing because we did not assume that the FOI is stationary over time; however, we used serological survey data to distinguish the FOI's age-and-time effect. The cohort-specific FOI peaked 18 years earlier in females than males, indicative of age-mixing patterns. We recommend interventions that target younger females so as to reduce HIV transmission rates.