Socioeconomic inequalities in the 90–90–90 target, among people living with HIV in 12 sub-Saharan African countries — Implications for achieving the 95–95–95 target — Analysis of population-based surveys

Background: Inequalities undermine efforts to end AIDS by 2030. We examined socioeconomic inequalities in the 90–90–90 target among people living with HIV (PLHIV) —men (MLHIV), women (WLHIV) and adolescents (ALHIV). Methods: We analysed the available Population HIV Impact Assessment (PHIA) survey data for each of the 12 sub-Saharan African countries, collected between 2015 and 2018 to estimate the attainment of each step of the 90–90–90 target by wealth quintiles. We constructed concentration curves, computed concentration indices (CIX) —a negative (positive) CIX indicated pro-poor (pro-rich) inequalities— and identified factors associated with, and contributing to inequality. Findings: Socioeconomic inequalities in achieving the 90–90–90 target components among PLHIV were noted in 11 of the 12 countries surveyed: not in Rwanda. Awareness of HIV positive status was pro-rich in 5/12 countries (Côte d'Ivoire, Tanzania, Uganda, Malawi, and Zambia) ranging from CIX=0·085 (p