1
|
Wechsberg WM, Carney T, Browne FA, van der Drift IM, Kline TL, Nyblade LL, Ndirangu J, Orrell C, Bonner CP, Caron E. Multilevel strategies to end HIV for young couples in Cape Town: Study protocol for a cluster randomized trial. PLoS One 2024; 19:e0305056. [PMID: 38848400 PMCID: PMC11161046 DOI: 10.1371/journal.pone.0305056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Abstract
This protocol presents a multilevel cluster randomized study in 24 communities in Cape Town, South Africa. The study comprises four specific aims. Aim 1, conducted during the formative phase, was to modify the original Couples Health CoOp (CHC) intervention to include antiretroviral therapy/pre-exposure prophylaxis (ART/PrEP), called the Couples Health CoOp Plus (CHC+), with review from our Community Collaborative Board and a Peer Advisory Board. Aim 1 has been completed for staging the trial. Aim 2 is to evaluate the impact of a stigma awareness and education workshop on community members' attitudes and behaviors toward young women and men who use AODs and people in their community seeking HIV services (testing/ART/PrEP) and other health services in their local clinics. Aim 3 is to test the efficacy of the CHC+ to increase both partners' PrEP/ART initiation and adherence (at 3 and 6 months) and to reduce alcohol and other drug use, sexual risk and gender-based violence, and to enhance positive gender norms and communication relative to HIV testing services (n = 480 couples). Aim 4 seeks to examine through mixed methods the interaction of the stigma awareness workshop and the CHC+ on increased PrEP and ART initiation, retention, and adherence among young women and their primary partners. Ongoing collaborations with community peer leaders and local outreach staff from these communities are essential for reaching the project's aims. Additionally, a manualized field protocol with regular training, fidelity checks, and quality assurance are critical components of this multilevel community trial for successful ongoing data collection. Trial registration. Clinicaltrials.gov Registration Number: NCT05310773. Pan African Trials: pactr.samrc.ac.za/ Registration Number: PACTR202205640398485.
Collapse
Affiliation(s)
- Wendee M. Wechsberg
- RTI International, Research Triangle Park, Durham, NC, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Tara Carney
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, Division of Addiction Psychiatry, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Felicia A. Browne
- RTI International, Research Triangle Park, Durham, NC, United States of America
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | | | - Tracy L. Kline
- RTI International, Research Triangle Park, Durham, NC, United States of America
| | | | | | - Catherine Orrell
- UCT Faculty of Health Sciences, Desmond Tutu Health Foundation, Observatory, Cape Town, South Africa
| | - Courtney P. Bonner
- RTI International, Research Triangle Park, Durham, NC, United States of America
| | - Emily Caron
- RTI International, Research Triangle Park, Durham, NC, United States of America
| |
Collapse
|
2
|
Alonso D, Vallès X. A potential transition from a concentrated to a generalized HIV epidemic: the case of Madagascar. Infect Dis Poverty 2023; 12:112. [PMID: 38057918 DOI: 10.1186/s40249-023-01164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study. METHODS We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers. RESULTS The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar. CONCLUSIONS These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.
Collapse
Affiliation(s)
- David Alonso
- Computational and Theoretical Ecology, Spanish Council for Scientific Research (CEAB-CSI)C, C/Access Cala Francesc, 14, 17300, Blanes, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), North Metropolitan Health Area From Barcelona, Hospital Universitari Germans Trias i Pujol, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain.
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, C/Canyet s/n, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, C/Canyet s/n, 08916, Badalona, Spain.
| |
Collapse
|
3
|
Teffo ME, Mokgatle MM. Assessing Condom Use and Views on HIV Counselling and Testing among TVET College Students in Limpopo Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6044. [PMID: 37297648 PMCID: PMC10252341 DOI: 10.3390/ijerph20116044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/07/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
South Africa's population is predominantly young, presenting a powerful resource for the country. Despite this, adolescents and young people remain at the epicentre of the HIV epidemic, particularly adolescent girls and young women (AGYW). There are limited studies that investigate the views on HIV Counselling and Testing (HCT) and condom use among adolescents and young people, and college students in particular, in South Africa. This cross-sectional study assessed condom use among college students and their views and opinions on HCT. Utilising an adapted questionnaire from the Australian Secondary students and the South African Sexual Health survey, the data from 396 students were analysed using univariate and multiple logistic regression performed using Stata IC version 16. The majority of the students (n = 339, 85.8%) had a sexual partner at the time of the study. Our findings reveal a relatively high occurrence of condom use in the last sexual encounter (n = 225, 60%) and high HCT uptake (n = 50, 88.4%). Females were generally more comfortable regarding HIV services compared to their male counterparts. More than half, 54.6% vs. 36.0% were comfortable about testing, 34.0% vs. 48.3% felt very scared about testing for HIV, 3.6% vs. 10.1% reported that they were not ready to take an HIV test, 7.6% vs. 5.6% intended getting tested soon (p = 0.0002). Condom use was significantly associated with the use of a condom during the first sexual encounter (aOR = 4.71, 95% CI: 2.14, 10.37) and knowing their partner's HIV status (aOR = 2.08, 95% CI: 1.19-3.65). The HCT and condom promotion strategies implemented by Higher Health in TVET colleges is showing success and colleges in other parts of the region could emulate these best practices. Program developers should consider tailor-made combinations of prevention interventions that would appeal to both female and male college students to improve condom use and uptake of HIV testing services.
Collapse
Affiliation(s)
- Mimi Eve Teffo
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria Ga-Rankuwa 0208, South Africa;
| | | |
Collapse
|
4
|
Zuma K, Simbayi L, Zungu N, Moyo S, Marinda E, Jooste S, North A, Nadol P, Aynalem G, Igumbor E, Dietrich C, Sigida S, Chibi B, Makola L, Kondlo L, Porter S, Ramlagan S. The HIV Epidemic in South Africa: Key Findings from 2017 National Population-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138125. [PMID: 35805784 PMCID: PMC9265818 DOI: 10.3390/ijerph19138125] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Abstract
South Africa has the largest number of people living with HIV worldwide. South Africa has implemented five population-based HIV prevalence surveys since 2002 aimed at understanding the dynamics and the trends of the epidemic. This paper presents key findings from the fifth HIV prevalence, incidence, and behaviour survey conducted in 2017 following policy, programme, and epidemic change since the prior survey was conducted in 2012. A cross-sectional population-based household survey collected behavioural and biomedical data on all members of the eligible households. A total of 39,132 respondents from 11,776 households were eligible to participate, of whom 93.6% agreed to be interviewed, and 61.1% provided blood specimens. The provided blood specimens were used to determine HIV status, HIV incidence, viral load, exposure to antiretroviral treatment, and HIV drug resistance. Overall HIV incidence among persons aged 2 years and above was 0.48% which translates to an estimated 231,000 new infections in 2017. HIV prevalence was 14.0% translating to 7.9 million people living with HIV. Antiretroviral (ARV) exposure was 62.3%, with the lowest exposure among those aged 15 to 24 years (39.9%) with 10% lower ARV coverage among males compared to females. Viral suppression among those on treatment was high (87.3%), whilst HIV population viral load suppression was much lower (62.3%). In terms of risk behaviours, 13.6% of youth reported having had an early sexual debut (first sex before the age of 15 years), with more males reporting having done so (19.5%) than females (7.6%). Age-disparate relationships, defined as having a sexual partner 5+ years different from oneself,) among adolescents were more common among females (35.8%) than males (1.5%). Self-reported multiple sexual partnerships (MSPs), defined as having more than one sexual partner in the previous 12 months, were more commonly reported by males (25.5%) than females (9.0%). Condom use at last sexual encounter was highest among males than females. Three quarters (75.2%) of people reported they had ever been tested for HIV, with more females (79.3%) having had done so than males (70.9%). Two-thirds of respondents (66.8%) self-reported having tested for HIV in the past 12 months. Finally, 61.6% of males in the survey self-reported as having been circumcised, with circumcision being more common among youth aged 15–24 years (70.2%), Black Africans (68.9%), and those living in both rural informal (tribal) areas (65%) and urban areas (61.9%). Slightly more (51.2%) male circumcisions were reported to have occurred in a medical setting than in traditional settings (44.8%), with more young males aged 15–24 (62.6%) and men aged 25–49 (51.5%) reporting to have done so compared to most men aged 50 and older (57.1%) who reported that they had undergone circumcision in a traditional setting. The results of this survey show that strides have been made in controlling the HIV epidemic, especially in the reduction of HIV incidence, HIV testing, and treatment. Although condom use at last sex act remains unchanged, there continue to be some challenges with the lack of significant behaviour change as people, especially youth, continue to engage in risky behaviour and delay treatment initiation. Therefore, there is a need to develop or scale up targeted intervention programmes to increase HIV testing further and put more people living with HIV on treatment as well as prevent risky behaviours that put young people at risk of HIV infection.
Collapse
Affiliation(s)
- Khangelani Zuma
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
- School of Public Health, University of the Witwatersrand, Johannesburg 2000, South Africa
- Correspondence:
| | - Leickness Simbayi
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7925, South Africa
| | - Nompumelelo Zungu
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
- The School of Nursing and Public Health, College of Health Sciences, Howard College Campus, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Sizulu Moyo
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7700, South Africa
| | - Edmore Marinda
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Sean Jooste
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
| | - Alicia North
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
| | - Patrick Nadol
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Getahun Aynalem
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Ehimario Igumbor
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa
| | - Cheryl Dietrich
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Salome Sigida
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Buyisile Chibi
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Lehlogonolo Makola
- Human Sciences Research Council, Cape Town 8000, South Africa; (L.S.); (S.M.); (S.J.); (A.N.); (L.M.)
| | - Lwando Kondlo
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | - Sarah Porter
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria 0001, South Africa; (P.N.); (G.A.); (E.I.); (C.D.); (S.P.)
| | - Shandir Ramlagan
- Human Sciences Research Council, Pretoria 0001, South Africa; (N.Z.); (E.M.); (S.S.); (B.C.); (L.K.); (S.R.)
| | | |
Collapse
|
5
|
Govender K, Beckett S, Reddy T, Cowden RG, Cawood C, Khanyile D, Kharsany ABM, George G, Puren A. Association of HIV Intervention Uptake With HIV Prevalence in Adolescent Girls and Young Women in South Africa. JAMA Netw Open 2022; 5:e228640. [PMID: 35452103 PMCID: PMC9034400 DOI: 10.1001/jamanetworkopen.2022.8640] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE In South Africa, adolescent girls and young women aged 15 to 24 years are among the most high-risk groups for acquiring HIV. Progress in reducing HIV incidence in this population has been slow. OBJECTIVE To describe HIV prevalence and HIV risk behaviors among a sample of adolescent girls and young women and to model the association between exposure to multiple or layered interventions and key HIV biological and behavioral outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey was conducted between March 13, 2017, and June 22, 2018, in 2 districts in Gauteng province and in 2 districts in KwaZulu-Natal province in South Africa. A stratified cluster random sampling method was used. Participants included adolescent girls and young women aged 12 to 24 years who lived in each sampled household. Overall, 10 384 participants were enrolled in Gauteng province and 7912 in KwaZulu-Natal province. One parent or caregiver was interviewed in each household. Data analysis was performed from March 12, 2021, to March 1, 2022. EXPOSURES DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe)-like interventions. MAIN OUTCOMES AND MEASURES The primary outcome was HIV prevalence. HIV status was obtained from laboratory-based testing of peripheral blood samples. Secondary outcomes included HIV testing and antiretroviral therapy uptake as well as numerous HIV risk variables that the DREAMS program sought to improve, such as pregnancy, sexually transmitted infection, intimate partner violence, and age-disparate sex. RESULTS The final sample included 18 296 adolescent girls and young women (median [IQR] age, 19 [15-21] years) in 10 642 households. Approximately half of participants (49.9%; n = 8414) reported engaging in sexual activity, and 48.1% (n = 3946) reported condom use at the most recent sexual encounter. KwaZulu-Natal province had a higher HIV prevalence than Gauteng province (15.1% vs 7.8%; P < .001). Approximately one-fifth of participants (17.6%; n = 3291) were not exposed to any interventions, whereas 43.7% (n = 8144) were exposed to 3 or more interventions. There was no association between exposure to DREAMS-like interventions and HIV status. Adolescent girls and young women who accessed 3 or more interventions were more likely to have undergone HIV testing (adjusted odds ratio, 2.39; 95% CI, 2.11-2.71; P < .001) and to have used condoms consistently in the previous 12 months (adjusted odds ratio, 1.68; 95% CI, 1.33-2.12; P < .001) than those who were not exposed to any interventions. CONCLUSIONS AND RELEVANCE Results of this study suggest that self-reported exposures to multiple or layered DREAMS-like interventions were associated with favorable behavioral outcomes. The beneficial aspects of layering HIV interventions warrant further research to support the sexual and reproductive health of adolescent girls and young women.
Collapse
Affiliation(s)
- Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Richard G. Cowden
- Human Flourishing Program, Harvard University, Cambridge, Massachusetts
| | - Cherie Cawood
- Epicentre AIDS Risk Management Limited, Cape Town, South Africa
| | - David Khanyile
- Epicentre AIDS Risk Management Limited, Cape Town, South Africa
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Gavin George
- Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa
| | - Adrian Puren
- National Institute for Communicable Diseases, Johannesburg, South Africa
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| |
Collapse
|
6
|
Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys. PLoS One 2021; 16:e0246309. [PMID: 33529246 PMCID: PMC7853509 DOI: 10.1371/journal.pone.0246309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
Context Nigeria is a high-burden country in terms of young people’s health. Understanding changes in young people’s sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. Objective This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria. Data and method We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. Results Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. Conclusion Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.
Collapse
|
7
|
George G, Cawood C, Puren A, Khanyile D, Gerritsen A, Govender K, Beckett S, Glenshaw M, Diallo K, Ayalew K, Gibbs A, Reddy T, Madurai L, Kufa-Chakezha T, Kharsany ABM. Evaluating DREAMS HIV prevention interventions targeting adolescent girls and young women in high HIV prevalence districts in South Africa: protocol for a cross-sectional study. BMC Womens Health 2020; 20:7. [PMID: 31948429 PMCID: PMC6966796 DOI: 10.1186/s12905-019-0875-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young women in sub-Saharan Africa remain at the epicentre of the HIV epidemic, with surveillance data indicating persistent high levels of HIV incidence. In South Africa, adolescent girls and young women (AGYW) account for a quarter of all new HIV infections. Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) is a strategy introduced by the United States President's Emergency Plan for AIDS Relief (PEPFAR) aimed at reducing HIV incidence among AGYW in 10 countries in sub-Saharan Africa by 25% in the programme's first year, and by 40% in the second year. This study will assess the change in HIV incidence and reduction in risk associated behaviours that can be attributed to the DREAMS initiative in South Africa, using a population-based cross-sectional survey. METHODS Data will be collected from a household-based representative sample of AGYW (between the ages 12-24 years) in four high prevalence districts (more than 10% of the population have HIV in these districts) in South Africa in which DREAMS has been implemented. A stratified cluster-based sampling approach will be used to select eligible participants for a cross-sectional survey with 18,500, to be conducted over 2017/2018. A questionnaire will be administered containing questions on sexual risk behaviour, selected academic and developmental milestones, prevalence of gender based violence, whilst examining exposure to DREAMS programmes. Biological samples, including two micro-containers of blood and self-collected vulvovaginal swab samples, are collected in each survey to test for HIV infection, HIV incidence, sexually transmitted infections (STIs) and pregnancy. This study will measure trends in population level HIV incidence using the Limiting antigen (LAg) Avidity Enzyme Immuno-Assay (EIA) and monitor changes in HIV incidence. DISCUSSION Ending the HIV/AIDS pandemic by 2030 requires the continual monitoring and evaluation of prevention programmes, with the aim of optimising efforts and ensuring the achievement of epidemic control. This study will determine the impact DREAMS interventions have had on HIV incidence among AGYW in a 'real world, non-trial setting'.
Collapse
Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), 4th Floor, J Block, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDs Risk Management (Pty) Limited, Paarl, South Africa
| | - Adrian Puren
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa
| | - David Khanyile
- Epicentre AIDs Risk Management (Pty) Limited, Paarl, South Africa
| | | | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), 4th Floor, J Block, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), 4th Floor, J Block, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
| | - Mary Glenshaw
- U.S. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Karidia Diallo
- U.S. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Kassahun Ayalew
- U.S. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa
| | - Andrew Gibbs
- Health Economics and HIV and AIDS Research Division (HEARD), 4th Floor, J Block, Westville Campus, University of KwaZulu-Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council (SAMRC), Pretoria, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Lorna Madurai
- Global Clinical and Virology Laboratory, Amanzimtoti, Durban, South Africa
| | - Tendesayi Kufa-Chakezha
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu-Natal South Africa
| |
Collapse
|
8
|
Age-disparate partnerships and incident HIV infection in adolescent girls and young women in rural South Africa. AIDS 2019; 33:83-91. [PMID: 30289813 DOI: 10.1097/qad.0000000000002037] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Adolescent girls and young women (AGYW) have a much higher risk of HIV infection than young men of the same age. One hypothesis for this disparity is AGYW are more likely to be in sexual partnerships with older men with HIV; however, evidence has been inconclusive. DESIGN We used longitudinal data from a randomized trial in South Africa (HPTN 068) to determined whether partner age difference is associated with incident HIV infection in AGYW. METHODS Age difference was examined continuously and dichotomously (≥5 years). We examined inverse probability of exposure weighted survival curves and calculated time-specific risk differences and risk ratios over 5.5 years of follow-up. We also used a marginal structural Cox model to estimate hazard ratios over the entire study period. RESULTS Risk of HIV was higher in AGYW with an age-disparate partnership versus not and the risk difference was largest at later time points. At 5.5 years, AGYW with an age-disparate partnership had a 12.6% (95% confidence interval 1.9-23.3) higher risk than AGYW with no age-disparate partnerships. The weighted hazard ratio was 1.91 (95% confidence interval 1.33-2.74), an association that remained after weighting for either transactional or condomless sex, and after examining continuous age-differences. CONCLUSION Age-disparate partnerships increased risk of HIV infection, even after accounting for transactional sex and condomless sex. The relationship between age-disparate partnerships and HIV infection may be explained by increased exposure to infection from men in a higher HIV prevalence pool rather than differences in sexual behaviour within these partnerships.
Collapse
|