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Garenne M. Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa. J Biosoc Sci 2023; 55:1156-1168. [PMID: 36286328 DOI: 10.1017/s0021932022000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study investigates the statistical relationship between male circumcision and HIV prevalence in Africa, in the context of the Voluntary Medical Male Circumcision (VMMC) campaigns in place since 2008. Data from the Population-based HIV Impact Assessment (PHIA) surveys conducted in African countries in 2017-2018 were utilized. Six countries with high HIV prevalence, low traditional circumcision and large VMMC programs were selected: Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe. The statistical analysis investigated the relative risk (RR) of HIV prevalence by circumcision status (circumcised vs intact) among men age 20-59, and the age-incidence of HIV in the two groups among men age 20-49, defined as the linear-logistic slope of the relationship between prevalence and age. Results show that the standardized RR was not different from 1 at older ages (50-59): RR = 0.923, 95% CI = 0.769-1.108, P = 0.390. Furthermore, the age-incidence was at least as high or higher among the circumcised groups than among the intact groups. The standardized RR was lower than 1 at younger ages, and this could be explained by selection biases. HIV prevalence at age 40-59 (27.3%) was also the same in the four groups of circumcision status (intact, traditional, medical, unknown). Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection. The study questions the current strategy of large scale VMMC campaigns to control the HIV epidemic. These campaigns also raise a number of ethical issues.
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Affiliation(s)
- Michel Garenne
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Extraordinary Professor, University of Western Cape, Department of Statistics and Population Studies, Cape Town, South Africa
- Senior Fellow, FERDI, Université d'Auvergne, Clermont-Ferrand, France
- Institut de Recherche pour le Développement (IRD), UMI Résiliences, Bondy, France
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Currie DW, West CA, Patel HK, Favaloro J, Asiimwe F, Ndagije F, Silver R, Mugurungi O, Shang J, Ndongmo CB, Williams DB, Dzinotyiweyi E, Waruru A, Pasipamire M, Nuwagaba-Biribonwoha H, Dlamini S, McLeod N, Kayirangwa E, Rwibasira G, Minchella PA, Auld AF, Nyirenda R, Getaneh Y, Hailemariam AH, Tondoh-Koui I, Kohemun N, Mgomella GS, Njau PF, Kirungi WL, Dalhatu I, Stafford KA, Bodika SM, Ussery F, McCracken S, Stupp P, Brown K, Duong YT, Parekh BS, Voetsch AC. Risk Factors for Recent HIV Infections among Adults in 14 Countries in Africa Identified by Population-Based HIV Impact Assessment Surveys, 2015-2019. Emerg Infect Dis 2023; 29:2325-2334. [PMID: 37877591 PMCID: PMC10617335 DOI: 10.3201/eid2911.230703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Identifying persons who have newly acquired HIV infections is critical for characterizing the HIV epidemic direction. We analyzed pooled data from nationally representative Population-Based HIV Impact Assessment surveys conducted across 14 countries in Africa for recent infection risk factors. We included adults 15-49 years of age who had sex during the previous year and used a recent infection testing algorithm to distinguish recent from long-term infections. We collected risk factor information via participant interviews and assessed correlates of recent infection using multinomial logistic regression, incorporating each survey's complex sampling design. Compared with HIV-negative persons, persons with higher odds of recent HIV infection were women, were divorced/separated/widowed, had multiple recent sex partners, had a recent HIV-positive sex partner or one with unknown status, and lived in communities with higher HIV viremia prevalence. Prevention programs focusing on persons at higher risk for HIV and their sexual partners will contribute to reducing HIV incidence.
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Payne D, Wadonda-Kabondo N, Wang A, Smith-Sreen J, Kabaghe A, Bello G, Kayigamba F, Tenthani L, Maida A, Auld A, Voetsch AC, Jonnalagadda S, Brown K, West CA, Kim E, Ogollah F, Farahani M, Dobbs T, Jahn A, Mirkovic K, Nyirenda R. Trends in HIV prevalence, incidence, and progress towards the UNAIDS 95-95-95 targets in Malawi among individuals aged 15-64 years: population-based HIV impact assessments, 2015-16 and 2020-21. Lancet HIV 2023; 10:e597-e605. [PMID: 37586390 PMCID: PMC10542580 DOI: 10.1016/s2352-3018(23)00144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND In 2014, UNAIDS set the goal of ending the AIDS epidemic by 2030 through the achievement of testing and treatment cascade targets. To evaluate progress achieved and highlight persisting gaps in HIV epidemic control in Malawi, we aimed to compare key indicators (prevalence, incidence, viral load suppression, and UNAIDS 95-95-95 targets) from the 2015-16 and 2020-21 Malawi Population-based HIV Impact Assessment (PHIA) survey results. METHODS The Malawi PHIAs were nationally representative, cross-sectional surveys with a two-stage cluster sampling design. The first survey was conducted between Nov 27, 2015, and Aug 26, 2016; the second survey was conducted between Jan 15, 2020, and April 26, 2021. Our analysis included survey participants aged 15-64 years. Participants were interviewed and a 14 mL blood sample was collected and tested for HIV infection using the national rapid testing algorithm. For each survey, we estimated key HIV epidemic indicators and achievement of 95-95-95 targets. The risk ratio (RR) of the indicators between surveys were computed and considered significant at a confidence level of 0·05. All results were weighted, and self-reported awareness and treatment status were adjusted to account for detection of antiretrovirals. FINDINGS Our analysis included 17 187 participants aged 15-64 years in 2015-16 and 21 208 in 2020-21 who participated in the surveys and blood draw. In the 2020-21 survey, 88·4% (95% CI 86·7-90·0) of people living with HIV were aware of their HIV-positive status; of those aware, 97·8% (97·1-98·5) were on antiretroviral therapy; and of those on treatment, 96·9% (95·9-97·7) were virally suppressed. Between surveys, the national HIV prevalence decreased significantly from 10·6% (10·0-11·2) to 8·9% (8·4-9·5) with RR 0·85 (95% CI 0·78-0·92; p<0·0001). The annual HIV incidence decreased from 0·37% (0·20-0·53) to 0·22% (0·11-0·34) with RR 0·61 (95% CI 0·31-1·20; p=0·15). The population viral load suppression increased from 68·3% (66·0-70·7) in 2015-16 to 87·0% (85·3-88·5) in 2020-21 (RR 1·27 [95% CI 1·22-1·32]; p<0·0001). INTERPRETATION These results suggest that Malawi had already surpassed the UNAIDS viral load suppression target for 2030 (85·7%) by 2020-21. Through strategies and evidence-informed interventions implemented in the last half decade, especially scale-up of effective HIV treatment, Malawi has made tremendous progress, including decreasing HIV prevalence and incidence and achieving both the second and third 95 targets ahead of 2030. To address the first 95, efforts in HIV diagnosis should focus on males and younger age groups. There is a continued need for effective linkage to care, retention on antiretroviral therapy, and adherence support to maintain and build on progress. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Danielle Payne
- US Centers for Disease Control and Prevention, Lilongwe, Malawi.
| | | | - Alice Wang
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | - Alinune Kabaghe
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - George Bello
- International Training and Education Center for Health, Lilongwe, Malawi
| | | | | | - Alice Maida
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Andrew Auld
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | | | - Kristin Brown
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Evelyn Kim
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | | | - Trudy Dobbs
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kelsey Mirkovic
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
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Godin A, Eaton JW, Giguère K, Marsh K, Johnson LF, Jahn A, Mbofana F, Ehui E, Maheu-Giroux M. Inferring population HIV incidence trends from surveillance data of recent HIV infection among HIV testing clients. AIDS 2021; 35:2383-2388. [PMID: 34261098 PMCID: PMC8631145 DOI: 10.1097/qad.0000000000003021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/26/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measuring recent HIV infections from routine surveillance systems could allow timely and granular monitoring of HIV incidence patterns. We evaluated the relationship of two recent infection indicators with alternative denominators to true incidence patterns. METHODS We used a mathematical model of HIV testing behaviours, calibrated to population-based surveys and HIV testing services programme data, to estimate the number of recent infections diagnosed annually from 2010 to 2019 in Côte d'Ivoire, Malawi, and Mozambique. We compared two different denominators to interpret recency data: those at risk of HIV acquisition (HIV-negative tests and recent infections) and all people testing HIV positive. Sex and age-specific longitudinal trends in both interpretations were then compared with modelled trends in HIV incidence, testing efforts and HIV positivity among HIV testing services clients. RESULTS Over 2010-2019, the annual proportion of the eligible population tested increased in all countries, while positivity decreased. The proportion of recent infections among those at risk of HIV acquisition decreased, similar to declines in HIV incidence among adults (≥15 years old). Conversely, the proportion of recent infections among HIV-positive tests increased. The female-to-male ratio of the proportion testing recent among those at risk was closer to 1 than the true incidence sex ratio. CONCLUSION The proportion of recent infections among those at risk of HIV acquisition is more indicative of HIV incidence than the proportion among HIV-positive tests. However, interpreting the observed patterns as surrogate measures for incidence patterns may still be confounded by different HIV testing rates between population groups or over time.
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Affiliation(s)
- Arnaud Godin
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Jeffrey W. Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Katia Giguère
- Centre de recherche du CHUM, Université de Montréal, Montréal, Quebec, Canada
| | | | - Leigh F. Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Andreas Jahn
- Department for HIV and AIDS, Ministry of Health and Population, Lilongwe, Malawi
- I-TECH, Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Eboi Ehui
- Programme National de lutte contre le SIDA, Abidjan, Côte d’Ivoire
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
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