Background: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA.Methods: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units.Results: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group.Conclusions: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Preserving landscape connectivity is one of the most frequently recommended strategies to address the synergistic threats of climate change, habitat fragmentation, and intensifying disturbances. Although assessments to develop plans for linked and connected landscapes in response to climate and land-use change have been increasingly employed in the last decade, efforts to operationalize and implement these plans have been limited. Here, we present a framework using existing, available biological data to design an implementable, comprehensive multispecies connectivity plan. This framework uses a scenario-based approach to consider how ecosystems, habitats, and species may need to adapt to future conditions with an ensemble of connectivity models. We use the south coast ecoregion of California as an example to evaluate and prioritize linkages by combining linked metapopulation models and key landscape features (e.g., conservation planning status and implementation feasibility) to identify and prioritize a multispecies linkage network. Our analyses identified approximately 30,000 km² of land, roughly one-fifth of our study area, where actions to preserve or enhance connectivity may support climate adaptation, nearly half of which is already conserved. By developing and implementing a dynamic connectivity assessment with an eye towards projected changes, our analysis demonstrates how dynamic connectivity can be integrated into feasible regional conservation and management plans that account for demographic as well as landscape change. We observed overlap across multiple models, reinforcing the importance of areas that appeared across methods. We also identified unique areas important for connectivity captured by our complementary models. By integrating multiple approaches, the resultant linkage network is robust, building on the strengths of a variety of methods to identify model consensus and reduce uncertainty. By linking quantitative connectivity metrics with prioritized areas for conservation, our approach supports transparent and robust decision-making for landscape planning, despite uncertainties of climate and land-use change.

The integration of immunization with other essential health services is among the strategic priorities of the Immunization Agenda 2030 and has the potential to improve the effectiveness, efficiency, and equity of health service delivery. This study aims to evaluate the degree of spatial overlap between the prevalence of children who have never received a dose of the diphtheria–tetanus–pertussis-containing vaccine (no-DTP) and other health-related indicators, to provide insight into the potential for joint geographic targeting of integrated service delivery efforts. Using geospatially modeled estimates of vaccine coverage and comparator indicators, we develop a framework to delineate and compare areas of high overlap across indicators, both within and between countries, and based upon both counts and prevalence. We derive summary metrics of spatial overlap to facilitate comparison between countries and indicators and over time. As an example, we apply this suite of analyses to five countries—Nigeria, Democratic Republic of the Congo (DRC), Indonesia, Ethiopia, and Angola—and five comparator indicators—children with stunting, under-5 mortality, children missing doses of oral rehydration therapy, prevalence of lymphatic filariasis, and insecticide-treated bed net coverage. Our results demonstrate substantial heterogeneity in the geographic overlap both within and between countries. These results provide a framework to assess the potential for joint geographic targeting of interventions, supporting efforts to ensure that all people, regardless of location, can benefit from vaccines and other essential health services.