Estimating District-Level HIV Incidence among Women in Malawi Using Antenatal Care (ANC) Data

Katherine Jia, Harvard University
Andreas Jahn, Directorate of HIV, STI, & Viral Hepatitis, Ministry of Health
Tiwonge Chimandule, Directorate of HIV, STI, & Viral Hepatitis, Ministry of Health
Rose Nyirenda, Directorate of HIV, STI, & Viral Hepatitis, Ministry of Health
Jeff Imai-Eaton, Harvard University

Levels of new HIV infections vary substantially at the subnational level, and trends may also vary, but data for incidence estimation at a finer spatial scale has historically been limited. Since 2011, in Malawi routine HIV testing in pregnant women attending antenatal care (ANC) facilities provided geographically-granular, high-coverage, and longitudinal data on HIV prevalence among pregnant women. Using the routinely-collected ANC data from the Department of HIV and AIDS Management Information System (DHA-MIS) in Malawi, we developed a mathematical model to estimate incidence in the general women aged 15 to 49 years old in 28 districts of Malawi, 2011-2020. We fitted the model and estimated that incidence was higher in districts of the Southern region than Northern or Central. While incidence declined in most districts from 2011 to 2020, incidence decreased in Southern and Central districts relatively more than the Northern districts.