Trends and Transitions of the Pediatric to Youth HIV Epidemic in Ghana

The primary objective of this study was to employ an integrated analytical framework to evaluate age-specific trends and the impact of interventions on pediatric and youth HIV epidemics. We used segmented regression, counterfactual analysis, generalised additive models (GAMs), and a new Epidemic Transition Score (ETS) to measure epidemic dynamics using World Bank data spanning from 1990 to 2024. Key findings show no decline in children living with HIV (p=0.402), but there are notable declining trends in new infections among children (Theil-Sen slope = -4.50, p<0.005) and youth (-6.15, p<0.005). Breakpoint analysis revealed important turning points that corresponded to PMTCT scale-up in 2000 and 2005 (p<0.0001). In contrast to a youth prevention gap (7,000–9,000 fewer averted), counterfactual modelling estimated 18,000–22,000 paediatric infections averted after 2005. A change from treatment-dominated (pre-2010) to balanced prevention-treatment strategies was indicated by the ETS metric. GAMs verified complex non-linear dynamics (edf=9.0) and disproportionate youth vulnerability (IRR=1.26, p<0.001). Three epidemic phases were objectively identified by disparity index clustering: youth-dominant (2011–2020; peak ratio=2.5 during COVID-19), transitional (1999–2010), and pediatric-dominant (1990–1998). We show that although paediatric interventions were successful, structural interventions that address the vulnerabilities and surveillance artefacts unique to adolescents are necessary to address persistent youth transmission.