Assessing Equity in PEPFAR Countries: Analysis of HIV Outcomes by Urban/Rural Residence, Wealth, Sex, and Age

Appendix Table 1
HIV Outcomes by Urban/Rural Status, 15 PEPFAR Countries
Country (Year) Percent Aware of HIV Status Percent on Treatment Percent Virally Suppressed
Rural Urban Difference Sig. Rural Urban Difference Sig. Rural Urban Difference Sig.
Botswana (2021) 95.4% 94.6% -0.9% *** 94.0% 93.0% -1.0% *** 92.0% 91.0% -1.0% ***
Cameroon (2017) 55.0% 56.0% 1.0% *** 51.0% 52.0% 1.0% *** 42.0% 41.0% -1.0% ***
Côte d’Ivoire (2017) 46.0% 51.5% 5.6% *** 44.0% 47.0% 3.0% *** 34.0% 34.0% 0.0% NS
Eswatini (2021) 94.0% 92.0% -2.0% *** 91.0% 90.0% -1.0% *** 88.0% 85.0% -3.0% ***
Ethiopia (2017)
Kenya (2018) 79.3% 79.3% 0.0% NS 76.0% 76.0% 0.0% NS 69.0% 70.0% 1.0% NS
Lesotho (2020) 90.3% 89.8% -0.6% *** 88.0% 87.0% -1.0% *** 79.0% 80.0% 1.0% ***
Malawi (2020) 89.0% 87.0% -2.0% *** 87.0% 84.0% -3.0% *** 85.0% 79.0% -6.0% ***
Mozambique (2021) 68.1% 75.4% 7.3% *** 66.0% 73.0% 7.0% *** 58.0% 66.0% 8.0% ***
Namibia (2017) 89.0% 83.0% -6.0% *** 86.0% 80.0% -6.0% *** 78.0% 73.0% -5.0% ***
Rwanda (2018) 82.0% 87.0% 5.0% * 80.0% 85.0% 5.0% NS 72.0% 77.0% 5.0% NS
Tanzania (2016) 56.0% 63.0% 7.0% *** 52.0% 59.0% 7.0% *** 46.0% 51.0% 5.0% ***
Uganda (2020) 79.0% 84.0% 5.0% *** 75.0% 81.0% 6.0% *** 69.0% 75.0% 6.0% ***
Zambia (2021) 88.5% 88.9% 0.3% *** 87.4% 86.6% -0.8% *** 85.0% 83.0% -2.0% ***
Zimbabwe (2020) 88.0% 85.0% -3.0% *** 86.0% 81.0% -5.0% *** 78.0% 73.0% -5.0% ***
Notes: * p<0.05, ** p<0.01, ***p<0.001, NS= Not significant based on Chi squared test or Fisher’s exact test. Difference represents the percentage point difference between the two groups. Results are based on the most recent PHIA survey for each country. Ethiopia’s PHIA doesn’t include data on urban/rural residence.
Appendix Table 2
HIV Outcomes by Wealth Quintile, 15 PEPFAR Countries
Country (Year) Percent Aware of HIV Status Percent on Treatment Percent Virally Suppressed
Lowest Highest Difference Sig. Lowest Highest Difference Sig. Lowest Highest Difference Sig.
Botswana (2021) 95.8% 95.4% -0.4% ** 94.0% 92.0% -2.0% *** 92.0% 91.0% -1.0% ***
Cameroon (2017) 40.0% 55.0% 15.0% *** 37.0% 51.0% 14.0% *** 26.0% 41.0% 15.0% ***
Côte d’Ivoire (2017) 58.0% 30.0% -28.0% *** 51.0% 29.0% -22.0% *** 40.0% 16.0% -24.0% ***
Eswatini (2021) 94.0% 92.0% -2.0% *** 93.0% 90.0% -3.0% *** 88.0% 87.0% -1.0% ***
Ethiopia (2017) 74.0% 76.0% 2.0% *** 71.0% 72.0% 1.0% *** 57.0% 68.0% 11.0% ***
Kenya (2018) 79.0% 77.0% -2.0% NS 75.0% 75.0% 0.0% NS 66.0% 71.0% 5.0% NS
Lesotho (2020) 89.0% 91.0% 2.0% *** 87.0% 88.0% 1.0% *** 79.0% 81.0% 2.0% ***
Malawi (2020) 87.0% 88.0% 1.0% *** 83.0% 86.0% 3.0% *** 80.0% 83.0% 3.0% ***
Mozambique (2021) 59.0% 78.0% 19.0% *** 55.0% 76.0% 21.0% *** 49.0% 70.0% 21.0% ***
Namibia (2017) 88.0% 75.0% -13.0% *** 86.0% 71.0% -15.0% *** 78.0% 58.0% -20.0% ***
Rwanda (2018) 82.0% 84.0% 2.0% NS 81.0% 81.0% 0.0% NS 73.0% 72.0% -1.0% NS
Tanzania (2016) 49.0% 63.0% 14.0% *** 46.0% 60.0% 14.0% *** 39.0% 51.0% 12.0% ***
Uganda (2020) 76.0% 85.0% 9.0% *** 71.0% 82.0% 11.0% *** 60.0% 79.0% 19.0% ***
Zambia (2021) 83.0% 90.0% 7.0% *** 81.0% 89.0% 8.0% *** 77.0% 85.0% 8.0% ***
Zimbabwe (2020) 89.0% 84.0% -5.0% *** 86.0% 80.0% -6.0% *** 77.0% 72.0% -5.0% ***
Notes: * p<0.05, ** p<0.01, ***p<0.001, NS= Not significant based on Chi squared test or Fisher’s exact test. Difference represents the percentage point difference between the two groups. Results are based on the most recent PHIA survey for each country.
Appendix Table 3
HIV Outcomes by Sex, 15 PEPFAR Countries
Country (Year) Percent Aware of HIV status Percent on Treatment Percent Virally Suppressed
Male Female Difference Sig. Male Female Difference Sig. Male Female Difference Sig.
Botswana (2021) 92.8% 96.1% 3.4% *** 90.0% 95.0% 5.0% *** 87.0% 93.0% 6.0% ***
Cameroon (2017) 51.2% 57.1% 5.9% *** 48.0% 53.0% 5.0% *** 39.0% 42.0% 3.0% ***
Côte d’Ivoire (2017) 40.0% 54.0% 14.0% *** 34.0% 51.0% 17.0% *** 22.0% 39.0% 17.0% ***
Eswatini (2021) 91.0% 94.0% 3.0% *** 88.0% 93.0% 5.0% *** 85.0% 89.0% 4.0% ***
Ethiopia (2017) 70.0% 82.0% 12.0% *** 69.0% 80.0% 11.0% *** 63.0% 68.0% 5.0% ***
Kenya (2018) 72.0% 83.0% 11.0% *** 68.0% 80.0% 12.0% *** 62.0% 72.0% 10.0% ***
Lesotho (2020) 88.0% 91.0% 3.0% *** 84.0% 89.0% 5.0% *** 76.0% 82.0% 6.0% ***
Malawi (2020) 85.0% 90.0% 5.0% *** 83.0% 89.0% 6.0% *** 80.0% 86.0% 6.0% ***
Mozambique (2021) 68.0% 73.0% 5.0% *** 65.0% 71.0% 6.0% *** 57.0% 64.0% 7.0% ***
Namibia (2017) 80.0% 89.0% 9.0% *** 75.0% 87.0% 12.0% *** 67.0% 80.0% 13.0% ***
Rwanda (2018) 80.0% 86.0% 6.0% * 78.0% 84.0% 6.0% * 67.0% 77.0% 10.0% ***
Tanzania (2016) 51.0% 63.0% 12.0% *** 46.0% 60.0% 14.0% *** 38.0% 53.0% 15.0% ***
Uganda (2020) 76.0% 83.0% 7.0% *** 72.0% 81.0% 9.0% *** 66.0% 75.0% 9.0% ***
Zambia (2021) 87.0% 90.0% 3.0% *** 85.0% 88.0% 3.0% *** 83.0% 84.0% 1.0% ***
Zimbabwe (2020) 84.0% 88.0% 4.0% *** 81.0% 86.0% 5.0% *** 72.0% 79.0% 7.0% ***
Notes: * p<0.05, ** p<0.01, ***p<0.001, NS= Not significant based on Chi squared test or Fisher’s exact test. Difference represents the percentage point difference between the two groups. Results are based on the most recent PHIA survey for each country.
Appendix Table 4
HIV Outcomes by Age, 15 PEPFAR Countries
Country (Year) Percent Aware of HIV status Percent on Treatment Percent Virally Suppressed
Age        < 25 Age ≥25 Difference Sig. Age        < 25 Age ≥25 Difference Sig. Age        < 25 Age ≥25 Difference Sig.
Botswana (2021) 84.5% 95.4% 10.9% *** 83.0% 93.0% 10.0% *** 76.0% 92.0% 16.0% ***
Cameroon (2017) 20.6% 59.8% 39.2% *** 19.0% 56.0% 37.0% *** 14.0% 45.0% 31.0% ***
Côte d’Ivoire (2017) 33.0% 51.0% 18.0% *** 32.0% 47.0% 15.0% *** 18.0% 35.0% 17.0% ***
Eswatini (2021) 85.0% 95.0% 10.0% *** 82.0% 92.0% 10.0% *** 73.0% 89.0% 16.0% ***
Ethiopia (2017) 63.0% 80.0% 17.0% *** 63.0% 77.0% 14.0% *** 47.0% 68.0% 21.0% ***
Kenya (2018) 70.0% 80.0% 10.0% * 65.0% 77.0% 12.0% * 52.0% 71.0% 19.0% ***
Lesotho (2020) 82.0% 91.0% 9.0% *** 78.0% 88.0% 10.0% *** 64.0% 81.0% 17.0% ***
Malawi (2020) 76.0% 89.0% 13.0% *** 73.0% 88.0% 15.0% *** 66.0% 85.0% 19.0% ***
Mozambique (2021) 54.0% 75.0% 21.0% *** 52.0% 72.0% 20.0% *** 41.0% 65.0% 24.0% ***
Namibia (2017) 71.0% 88.0% 17.0% *** 70.0% 84.0% 14.0% *** 60.0% 77.0% 17.0% ***
Rwanda (2018) 69.0% 85.0% 16.0% *** 66.0% 83.0% 17.0% *** 56.0% 75.0% 19.0% ***
Tanzania (2016) 49.0% 60.0% 11.0% *** 45.0% 56.0% 11.0% *** 38.0% 49.0% 11.0% ***
Uganda (2020) 60.0% 84.0% 24.0% *** 57.0% 81.0% 24.0% *** 49.0% 75.0% 26.0% ***
Zambia (2021) 73.0% 90.0% 17.0% *** 72.0% 89.0% 17.0% *** 67.0% 86.0% 19.0% ***
Zimbabwe (2020) 75.4% 88.0% 12.6% *** 72.0% 86.0% 14.0% *** 58.0% 78.0% 20.0% ***
Notes: * p<0.05, ** p<0.01, ***p<0.001, NS= Not significant based on Chi squared test or Fisher’s exact test. Difference represents the percentage point difference between the two groups. Results are based on the most recent PHIA survey for each country.
Appendix Table 5
Changes in HIV Outcomes Over Time, Six Countries
Population sub-group Percent Aware of HIV status Percent on Treatment Percent Virally Suppressed
PHIA 1 PHIA 2 Difference (Within Group) PHIA 1 PHIA 2 Difference (Within Group) PHIA 1 PHIA 2 Difference (Within Group)
Eswatini (2016, 2021)
Urban/Rural
Rural 88.6% 93.7% 5.1% 79.1% 91.5% 12.4% 72.0% 88.0% 16.0%
Urban 83.0% 92.0% 9.0% 73.0% 90.0% 17.0% 67.5% 85.0% 17.5%
Wealth
Lowest 89.6% 94.8% 5.2% 81.0% 93.0% 12.0% 72.6% 88.5% 15.9%
Highest 85.0% 92.0% 7.0% 74.0% 91.1% 17.1% 68.5% 87.7% 19.2%
Sex
Male 80.0% 91.0% 11.0% 72.0% 88.0% 16.0% 65.0% 85.0% 20.0%
Female 91.0% 94.0% 3.0% 80.0% 93.0% 13.0% 73.0% 89.0% 16.0%
Age
Age <25 72.0% 85.0% 13.0% 61.0% 82.0% 21.0% 47.0% 73.6% 26.6%
Age ≥25 88.9% 94.6% 5.7% 79.0% 92.0% 13.0% 75.0% 89.0% 14.0%
Lesotho (2016, 2021)
Urban/Rural
Rural 81.0% 90.0% 9.0% 75.0% 88.0% 13.0% 66.6% 79.2% 12.6%
Urban 81.0% 90.0% 9.0% 73.0% 86.0% 13.0% 63.3% 79.6% 16.3%
Wealth
Lowest 80.0% 89.0% 9.0% 74.0% 87.0% 13.0% 65.0% 79.0% 14.0%
Highest 84.0% 91.0% 7.0% 76.0% 88.0% 12.0% 67.0% 81.0% 14.0%
Sex
Male 77.0% 88.0% 11.0% 70.0% 84.0% 14.0% 61.0% 76.0% 15.0%
Female 84.0% 91.0% 7.0% 77.0% 89.0% 12.0% 68.0% 82.0% 14.0%
Age
Age <25 68.0% 82.0% 14.0% 61.0% 78.0% 17.0% 47.3% 63.6% 16.3%
Age ≥ 25 82.0% 90.0% 8.0% 76.0% 88.0% 12.0% 67.0% 81.0% 14.0%
Malawi (2015, 2020)
Urban/Rural
Rural 78.0% 89.0% 11.0% 72.0% 87.0% 15.0% 66.0% 85.0% 19.0%
Urban 73.0% 87.0% 14.0% 66.0% 84.0% 18.0% 59.0% 80.0% 21.0%
Wealth
Lowest 73.0% 87.0% 14.0% 65.0% 84.0% 19.0% 60.0% 80.0% 20.0%
Highest 74.0% 88.0% 14.0% 68.0% 86.0% 18.0% 62.0% 83.0% 21.0%
Sex
Male 72.0% 85.0% 13.0% 63.0% 83.0% 20.0% 57.0% 80.0% 23.0%
Female 80.0% 90.0% 10.0% 74.0% 89.0% 15.0% 68.0% 86.0% 18.0%
Age
Age <25 54.0% 76.0% 22.0% 46.0% 73.0% 27.0% 37.0% 66.0% 29.0%
Age ≥ 25 79.0% 89.0% 10.0% 72.0% 88.0% 16.0% 67.0% 85.0% 18.0%
Uganda (2016, 2020)
Urban/Rural
Rural 73.0% 79.0% 6.0% 66.0% 75.0% 9.0% 55.0% 69.0% 14.0%
Urban 72.0% 84.0% 12.0% 65.0% 81.0% 16.0% 55.3% 75.5% 20.2%
Wealth
Lowest 71.0% 76.0% 5.0% 60.0% 71.0% 11.0% 46.0% 60.0% 14.0%
Highest 71.5% 84.7% 13.2% 65.0% 82.0% 17.0% 56.0% 79.0% 23.0%
Sex
Male 67.0% 76.0% 9.0% 58.5% 72.1% 13.6% 48.0% 66.0% 18.0%
Female 75.0% 83.0% 8.0% 69.4% 80.8% 11.4% 59.0% 75.0% 16.0%
Age
Age <25 48.0% 60.0% 12.0% 44.0% 57.0% 13.0% 33.0% 49.0% 16.0%
Age ≥ 25 77.0% 84.0% 7.0% 69.0% 81.0% 12.0% 58.4% 74.9% 16.5%
Zambia (2016, 2021)
Urban/Rural
Rural 66.0% 89.0% 23.0% 56.0% 87.0% 31.0% 51.0% 85.0% 34.0%
Urban 74.0% 89.0% 15.0% 65.0% 87.0% 22.0% 58.7% 82.5% 23.8%
Wealth
Lowest 64.0% 83.0% 19.0% 51.0% 80.0% 29.0% 43.0% 77.0% 34.0%
Highest 79.0% 90.0% 11.0% 71.0% 89.0% 18.0% 64.0% 85.0% 21.0%
Sex
Male 69.0% 87.0% 18.0% 61.0% 85.0% 24.0% 53.6% 83.0% 29.4%
Female 72.0% 90.0% 18.0% 62.0% 88.0% 26.0% 56.0% 84.0% 28.0%
Age
Age <25 46.0% 73.0% 27.0% 38.0% 72.0% 34.0% 28.0% 67.0% 39.0%
Age ≥ 25 75.0% 90.0% 15.0% 65.0% 89.0% 24.0% 59.6% 86.0% 26.4%
Zimbabwe (2015, 2020)
Urban/Rural
Rural 77.9% 87.8% 9.9% 69.5% 85.6% 16.1% 59.3% 77.5% 18.2%
Urban 75.0% 84.6% 9.6% 65.7% 81.1% 15.4% 56.2% 72.7% 16.5%
Wealth
Lowest 79.2% 88.6% 9.4% 71.2% 86.2% 15.0% 59.9% 77.4% 17.5%
Highest 75.9% 83.6% 7.7% 65.6% 80.3% 14.7% 56.9% 72.1% 15.2%
Sex
Male 72.2% 84.3% 12.1% 63.9% 80.9% 17.0% 52.8% 72.0% 19.2%
Female 80.0% 88.3% 8.3% 71.0% 86.2% 15.2% 61.8% 78.5% 16.7%
Age
Age <25 60.3% 75.4% 15.1% 52.4% 71.9% 19.5% 43.2% 58.2% 15.0%
Age ≥ 25 78.9% 88.1% 9.2% 70.1% 85.5% 15.4% 60.0% 78.0% 18.0%
Notes: *All changes were significant at the p<0.05, ** p<0.01, or ***p<0.001 level. Difference represents the percentage point difference between surveys by subgroup.
Appendix Table 6
Changes in HIV Outcome Gap Over Time, by Country (Green = Gap Narrowed)
Population
sub-group
Percent Aware of HIV Status Percent on Treatment Percent Virally Suppressed
PHIA1 PHIA2 PHIA1 PHIA2 PHIA1 PHIA2
Eswatini (2016, 2021)
Urban/Rural Gap -5.6 -1.7 -6.1 -1.5 -4.5 -3.0
High/Low Wealth Quintile Gap -4.6 -2.8 -7.0 -1.9 -4.1 -0.8
Female/Male Gap 11.0 3.0 8.0 5.0 8.0 4.0
Younger/Older Age Gap 16.9 9.6 18.0 10.0 28.0 15.4
Lesotho (2016, 2021) 
Urban/Rural Gap 0.0 0.0 -2.0 -2.0 -3.3 0.4
High/Low Wealth Quintile Gap 4.0 2.0 2.0 1.0 2.0 2.0
Female/Male Gap 7.0 3.0 7.0 5.0 7.0 6.0
Younger/Older Age Gap 14.0 8.0 15.0 10.0 19.7 17.4
 Malawi (2015, 2020)
Urban/Rural Gap -5.0 -2.0 -6.0 -3.0 -7.0 -5.0
High/Low Wealth Quintile Gap 1.0 1.0 3.0 2.0 2.0 3.0
Female/Male Gap 8.0 5.0 11.0 6.0 11.0 6.0
Younger/Older Age Gap 25.0 13.0 26.0 15.0 30.0 19.0
 Uganda (2016, 2020)
Urban/Rural Gap -1.0 5.0 -1.0 6.0 0.3 6.5
High/Low Wealth Quintile Gap 0.5 8.7 5.0 11.0 10.0 19.0
Female/Male Gap 8.0 7.0 10.9 8.7 11.0 9.0
Younger/Older Age Gap 29.0 24.0 25.0 24.0 25.4 25.9
Zambia (2016, 2021)  
Urban/Rural Gap 8.0 0.0 9.0 0.0 7.7 -2.5
High/Low Wealth Quintile Gap 15.0 7.0 20.0 9.0 21.0 8.0
Female/Male Gap 3.0 3.0 1.0 3.0 2.4 1.0
Younger/Older Age Gap 29.0 17.0 27.0 17.0 31.6 19.0
Zimbabwe (2015, 2020) 
Urban/Rural Gap -2.9 -3.2 -3.8 -4.5 -3.1 -4.9
High/Low Wealth Quintile Gap -3.3 -5.0 -5.6 -5.9 -3.0 -5.3
Female/Male Gap 7.8 4.0 7.1 5.3 9.0 6.5
Younger/Older Age Gap 18.6 12.6 17.7 13.6 16.8 19.8
Notes: Difference represents the percentage point difference between subgroups in each survey period.
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