摘要：Background People's knowledge of and attitude to HIV/AIDS are key contributors to the success of public-health interventions. However, evidence on country-level HIV/AIDS knowledge and attitudes is still scarce across sub-Saharan countries. To address this knowledge gap, we have gathered evidence to estimate national trends in HIV/AIDS knowledge and attitude from 1990 to 2017 across 46 sub-Saharan African countries. Methods We retrieved national surveys that have indicators of HIV/AIDS knowledge and attitude from Global Health Data Exchange (GHDx). There are ten indicators of knowledge of HIV transmission and risk reduction and four indicators that reflect attitude towards people living with HIV/AIDS. We extracted individual-level data on knowledge and attitude in a systematic and consistent way and collapsed these into country-level estimates. Multi-level multiple imputation was used to impute missing indicators on country level and we used spatial-temporal Gaussian process regression (ST-GPR) to estimate the trend of each indicator in each country. Findings We included 313 national surveys in the study. From 1990 to 2017, most knowledge indicators slightly increased across all countries. However, the trends of knowledge on HIV mother-to-child transmission during pregnancy vary between countries, with significant decreasing trends in 18 of 46 countries including Kenya, Rwanda, and Zambia. For the attitude factors, we noted that the factors “willing to frequent a HIV-positive vendor”, “willing to take care of a HIV-positive family members in the house”, and “belief that a HIV-positive teacher should continue to work” all increased across countries. However, across the study period, people have become more reluctant to reveal a family member's positive status. In addition, our results indicate that men are slightly more knowledgeable about HIV/AIDS than are women. Interpretation In sub-Saharan African countries, knowledge of HIV/AIDS increased slightly between 1990 and 2017, with people becoming more accepting of people with HIV/AIDS. Of concern is that knowledge about prevention of mother-to-child HIV transmission during pregnancy has not been improving as much, and is even decreasing in some countries. Of similar concern is that people are now less likely to reveal a family member's positive HIV status, suggesting that discrimination against people living with HIV/AIDS is still persistent and may be becoming worse. Efforts and resources are still needed to turn the tide in these areas. Funding US National Institutes of Health and Bill & Melinda Gates Foundation.
