# Projecting the age shift in HIV prevalence in sub-Saharan Africa: a necessary epidemiologic step to prepare for the silver tsunami

> **NIH NIH R21** · UNIVERSITY OF MARYLAND BALTIMORE · 2024 · $213,886

## Abstract

PROJECT SUMMARY
Epidemiologic models have predicted that by 2040, 27% of the population living with HIV in sub-Saharan Africa
(SSA) will be 50 years of age or older; however, these models appear to underestimate both the timing and
magnitude of the age shift. As of 2022, 21% of all people on antiretroviral therapy (ART) in countries supported
by the President's Emergency Plan for AIDS Relief are 50 years of age and older. As the HIV epidemic in SSA
comes under control—with more people living with HIV (PLWH) diagnosed, placed on ART, and achieving viral
suppression—updated models are needed to more accurately predict and plan for coming demands on the
HIV-related healthcare system.
The burden of HIV-associated noncommunicable diseases (NCD) is well documented, and risk rises markedly
with age. With increases in life expectancy among PLWH, healthcare resource limitations, increased focus on
integrating NCD management into HIV platforms, and the imperative to achieve and sustain HIV control in all
subpopulations, models that accurately capture and predict the age distribution and NCD burden of PLWH are
critical to address knowledge gaps and support precision program implementation.
We posit that countries in SSA with high HIV burden will experience the shift in the age distribution to greater
than 50% of PLWH over the age of 50 at least a decade sooner than predicted by more commonly used
models. Botswana and Zambia are two settings with different epidemic characteristics, providing a unique
opportunity to develop and test a new demographic prediction model for more accurate prediction of this “silver
tsunami” in PLWH and NCD burden. The goal of this study is to use repeated nationally representative
data from Botswana and Zambia to develop a cohort model with age-stratified transmission risk that
predicts the age distribution and NCD burden among PLWH through 2050.
The proposed Epidemiologic Predictions to Inform Programs for Long-term Aging Needs among people living
with HIV (EPI-PLAN HIV) project will generate a framework for accurate prediction of both the age shift and
NCD risk in aging populations of PLWH through the following aims 1) Characterize sexual networks in
Botswana and Zambia using repeated HIV population-based survey data, 2) Build a cohort model with age-
stratified HIV transmission risk to predict the age distribution among PLWH over time, and 3) Predict the
burden of NCD among PLWH in Botswana and Zambia over time. The outcomes of this project will be used to
accelerate the health system's response and serve as the foundation for future research into the growing
burden of NCD in PLWH in SSA.

## Key facts

- **NIH application ID:** 10912767
- **Project number:** 5R21AI179493-02
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Kristen A. Stafford
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $213,886
- **Award type:** 5
- **Project period:** 2023-08-23 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10912767

## Citation

> US National Institutes of Health, RePORTER application 10912767, Projecting the age shift in HIV prevalence in sub-Saharan Africa: a necessary epidemiologic step to prepare for the silver tsunami (5R21AI179493-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10912767. Licensed CC0.

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