A systematic review and meta-analysis of the prevalence, trends and spatiotemporal distribution of HIV/AIDS infection in Northern African countries.

Abstract Background: Human immune deficiency virus (HIV) infection is a major global public health concern. Northern African countries carry a disproportionate burden of HIV, accounting for one of the highest prevalences in Africa. Here in, we sought to analyze the epidemiological characterization and spatial trends of HIV infection in the Northern African region.Methods: A systematic review was carried out on all the published data regarding HIV/AIDS in Northern African countries over a ten year period ( 2008-2017) following the PRISMA guidelines. We performed a comprehensive literature search using Medline PubMed, Embase, regional and international databases, and country-level reports were searched with no language restriction. The quality, quantity, and geographic coverage of the data were assessed at both the country and region levels. We used random-effects methods, spatial variables and stratified results by demographic factors. Only original data for the prevalence of HIV infection were included and independently evaluated by professional epidemiologists.Results: A total of 721 records were identified by our data search , and only 41 that met our criteria were included in the meta-analysis during the study period. There was a considerable variability in the prevalence estimates of HIV within the countries of the region. The overall prevalence of HIV in northern African countries ranged from 0.9% (95% CI (0.8–1.27) to 3.8% (95% CI (1.17-6 .53)). The highest prevalence was associated with vulnerable groups, particularly drug abusers and sexual promiscuity. Dense HIV clustering was also reported during the study period, varying from one country to another. At least 13 HIV subtypes and recombinant forms were prevalent in the region. Subtype B was the most common variant , followed by CRF02_AG.Conclusion: This comprehensive review indicated that HIV infection in Northern African countries is an emerging threat. Effective strategies are needed both at national and regional levels to improve monitoring and controlling the transmission of HIV with a particular emphasis on geographic variability and HIV clustering.