Progress toward HIV elimination goals: trends in and projections of annual HIV testing and condom use in Africa

To estimate trends in and projections of annual HIV testing and condom use at last higher-risk sex; and to calculate the probability of reaching key UNAIDS's target. We included 114 nationally-representative datasets in 38 African countries from DHS and MICS with 1456224 sexually active adults age 15-49 from 2003 to 2018. We applied Bayesian mixed effect models to estimate the coverage of annual HIV testing and condom use at last higher-risk sex for every country and year to 2030; and the probability of reaching UNAIDS testing and condom use targets of 95% coverage by 2030. Seven countries saw downward trends in annual HIV testing and four saw decreases in condom use at higher-risk sex, while most countries have upward trends in both indicators. The highest coverages of testing in 2030 are predicted in Swaziland with 92.6% (95% Credible Interval: 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 were very low for both HIV testing (0% to 28.5%) and condom use (0% to 12.1%). We observed limited progress on annual HIV testing and condom use at last higher-risk sex in Africa, and little prospect of reaching global targets for HIV/AIDS elimination. Although some funding agencies are considering withdrawal from supporting Africa, more attention to funding and expanding testing and treatment are needed in this region.