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Schnure MC, Kasaie P, Dowdy DW, Genberg BL, Kendall EA, Fojo AT. Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya. AIDS 2024; 38:1375-1385. [PMID: 38537051 PMCID: PMC11211060 DOI: 10.1097/qad.0000000000003895] [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] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES To provide accurate forecasts of the age distribution of people with HIV (PWH) in Kenya from 2025 to 2040. DESIGN Development of a compartmental model of HIV in Kenya, calibrated to historical estimates of HIV epidemiology. METHODS We forecasted changes in population size and age distribution of new HIV infections and PWH under the status quo and under scale-up of HIV services. RESULTS Without scale-up, new HIV infections were forecasted to fall from 34 000 (28 000-41 000) in 2,025 to 29 000 (15 000-57 000) in 2,040; the percentage of new infections occurring among persons over 30 increased from 33% (20-50%) to 40% (24-62%). The median age of PWH increased from 39 years (38-40) in 2025 to 43 years (39-46) in 2040, and the percentage of PWH over age 50 increased from 26% (23-29%) to 34% (26-43%). Under the full intervention scenario, new infections were forecasted to fall to 6,000 (3,000-12 000) in 2,040. The percentage of new infections occurring in people over age 30 increased to 52% (34-71%) in 2,040, and there was an additional shift in the age structure of PWH [forecasted median age of 46 (43-48) and 40% (33-47%) over age 50]. CONCLUSION PWH in Kenya are forecasted to age over the next 15 years; improvements to the HIV care continuum are expected to contribute to the growing proportion of older PWH.
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Affiliation(s)
| | - Parastu Kasaie
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David W. Dowdy
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Becky L. Genberg
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Birri Makota RB, Musenge E. Estimating HIV incidence over a decade in Zimbabwe: A comparison of the catalytic and Farrington models. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001717. [PMID: 37708116 PMCID: PMC10501625 DOI: 10.1371/journal.pgph.0001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Abstract
Over the years, numerous modelling studies have been proposed to estimate HIV incidence. As a result, this study aimed to evaluate two alternative methods for predicting HIV incidence in Zimbabwe between 2005 and 2015. We estimated HIV incidence from seroprevalence data using the catalytic and Farrington-2-parameter models. Data were obtained from 2005-06, 2010-11, and 2015 Zimbabwe Demographic Health Survey (ZDHS). These models were validated at the micro and macro-level using community-based cohort incidence and empirical estimates from UNAIDS EPP/SPECTRUM, respectively. The HIV incidence for the catalytic model was 0.32% (CI: 0.28%, 0.36%), 0.36% (CI: 0.33%, 0.39%), and 0.28% (CI: 0.26%, 0.30%), for the years 2005-06, 2010-11, and 2015, respectively. The HIV incidence for the Farrington model was 0.21% (CI: 0.16%, 0.26%), 0.22% (CI: 0.20%, 0.25%), and 0.19% (CI: 0.16%, 0.22%), for the years 2005-06, 2010-11, and 2015, respectively. According to these findings, the catalytic model estimated a higher HIV incidence rate than the Farrington model. Compared to cohort estimates, the estimates were within the observed 95% confidence interval, with 88% and 75% agreement for the catalytic and Farrington models, respectively. The limits of agreement observed in the Bland-Altman plot were narrow for all plots, indicating that our model estimates were comparable to cohort estimates. Compared to UNAIDS estimates, the catalytic model predicted a progressive increase in HIV incidence for males throughout all survey years. Without a doubt, HIV incidence declined with each subsequent survey year for all models. To improve programmatic and policy decisions in the national HIV response, we recommend the triangulation of multiple methods for incidence estimation and interpretation of results. Multiple estimating approaches should be considered to reduce uncertainty in the estimations from various models.
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Affiliation(s)
- Rutendo Beauty Birri Makota
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Birri Makota R, Musenge E. Estimating age specific prevalence and force of infection in Zimbabwe using combined cross-sectional surveys from 2005 to 2015. FRONTIERS IN EPIDEMIOLOGY 2022; 2:1029583. [PMID: 38455313 PMCID: PMC10911038 DOI: 10.3389/fepid.2022.1029583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/14/2022] [Indexed: 03/09/2024]
Abstract
Objective Age structured sexual mixing patterns have been noted to be associated with HIV prevalence and force of infection. Therefore, this study aimed to estimate the age dependent HIV force of infection using survey cross-sectional data from Zimbabwe. Methods We fit generalized additive models namely; linear, semi-parametric, non-parametric and non-proportional hazards models. Using the 2005-06, 2010-11 and 2015 Zimbabwe Demographic Health Surveys data. The Akaike Information Criteria was used to select the best model. The best model was then used to estimate the age dependent HIV prevalence and force-of-infection. Results Based on birth year cohort-specific prevalence, the female HIV prevalence reaches the highest peak at around 29 years of age, then declines thereafter. Males have a lower cohort specific prevalence between 15 and 30 years than females. Male cohort-specific prevalence slightly decreases between the ages of 33 and 39, then peaks around the age of 40. The cohort-specific FOI is greater in females than in males throughout all age categories. In addition, the cohort-specific HIV FOI peaked at ages 22 and 40 for females and males, respectively. The observed 18-year age difference between the HIV FOI peaks of males and females. Conclusion Our model was appealing because we did not assume that the FOI is stationary over time; however, we used serological survey data to distinguish the FOI's age-and-time effect. The cohort-specific FOI peaked 18 years earlier in females than males, indicative of age-mixing patterns. We recommend interventions that target younger females so as to reduce HIV transmission rates.
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Affiliation(s)
- Rutendo Birri Makota
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nouaman MN, Becquet V, Plazy M, Coffie PA, Zébago C, Montoyo A, Anoma C, Eholié S, Dabis F, Larmarange J. Incidence of HIV infection and associated factors among female sex workers in Côte d’Ivoire, results of the ANRS 12361 PrEP-CI study using recent infection assays. PLoS One 2022; 17:e0271988. [PMCID: PMC9671321 DOI: 10.1371/journal.pone.0271988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to estimate, using an HIV Recent Infection Testing Algorithm (RITA), the HIV incidence and its associated factors among female sex workers (FSW) in Côte d’Ivoire. Methods A cross-sectional study was conducted in 2016–2017 in Abidjan and San Pedro’s region among FSW aged ≥ 18 years. In addition, a sociodemographic questionnaire, HIV screening was carried out by two rapid tests. In the event of a positive result, a dried blood spot sample was taken to determine, using a RITA adapted to the Ivorian context, if it was a recent HIV infection. Results A total of 1000 FSW were surveyed with a median age of 25 years (interquartile range: 21–29 years). 39 (3.9%) tested positive for HIV. The incidence of HIV was estimated to be 2.3 per 100 person-years, with higher incidence rates among those 24 years old or less (3.0% vs. 1.9%), non-Ivorian FSW (3.2% vs. 1.9%) and those with the lowest education level (4.6% in FSW who never went to school vs. 2.6%). The incidence seemed to be associated with the sex work practice conditions: higher incidence among FSW whose usual price was less than 3.50$ (4.3% vs.1.0%), FSW who had a larger number of clients on the last day of work (6.1% in those with 7 clients or more vs. 1.8%), FSW who reported not always using condoms with their clients (8.5% vs. 1.5%) and FSW who reported agreeing to sex without a condom in exchange for a large sum of money (10.1% vs. 1.2%). Conclusion This study confirms that FSW remain highly exposed to HIV infection. Exposure to HIV is also clearly associated with certain sex-work factors and the material conditions of sex work. Efforts in the fight against HIV infection must be intensified to reduce new infections among FSW.
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Affiliation(s)
- Marcellin N. Nouaman
- Programme PAC-CI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire
- Département de Santé Publique et d’odontologie légale, UFR d’Odonto-Stomatologie, Université Félix Houphouet-Boigny, Abidjan, Côte d’Ivoire
- * E-mail:
| | - Valentine Becquet
- Ined, Aubervilliers, France
- Ceped, IRD, Université de Paris, Inserm, Paris, France
| | - Mélanie Plazy
- Bordeaux Population Health Research Center, Université de Bordeaux, Inserm, IRD, Bordeaux, France
| | - Patrick A. Coffie
- Programme PAC-CI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire
- Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouet Boigny, Abidjan, Côte d’Ivoire
| | | | | | | | - Serge Eholié
- Programme PAC-CI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d’Ivoire
- Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouet Boigny, Abidjan, Côte d’Ivoire
| | - François Dabis
- Bordeaux Population Health Research Center, Université de Bordeaux, Inserm, IRD, Bordeaux, France
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Hamidouche M, Ante-Testard PA, Baggaley R, Temime L, Jean K. Monitoring socioeconomic inequalities across HIV knowledge, attitudes, behaviours and prevention in 18 sub-Saharan African countries. AIDS 2022; 36:871-879. [PMID: 35190511 DOI: 10.1097/qad.0000000000003191] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Socioeconomic inequalities in HIV prevention services coverage constitute important barriers to global prevention targets, especially in sub-Saharan Africa (SSA). We aimed at monitoring these inequalities from population-based survey data in 18 SSA countries between 2010 and 2018. METHODS We defined eight HIV indicators aimed at capturing uptake of HIV prevention services among adult participants. Country-specific wealth-related inequalities were measured using the Relative and Slope Index of Inequalities (RII and SII, respectively) and then pooled using random-effects meta-analyses. We compared inequalities between African regions using the Wilcoxon rank-sum test. RESULTS The sample consisted of 358 591 participants (66% women). Despite variability between countries and indicators, the meta-analysis revealed significant levels of relative and absolute inequalities in six out of eight indicators: HIV-related knowledge, positive attitudes toward people with HIV (PWH), condom use at last sexual intercourse, participation to prevention of mother-to-child transmission programs, medical male circumcision and recent HIV testing. The largest inequalities were reported in condom use, with condom use reported five times more among the richest versus the poorest [RII = 5.02, 95% confidence interval (CI) 2.79-9.05] and in positive attitudes toward PWH, with a 32-percentage point difference between the richest and poorest (SII = 0.32, 95% CI 0.26-0.39). Conversely, no significant inequalities were observed in multipartnership and HIV seropositivity among youth. Overall, inequalities tended to be larger in West and Central vs. East and Southern African countries. CONCLUSION Despite efforts to scale-up HIV-prevention programs, socioeconomic inequalities remain substantial over the continuum of HIV primary and secondary prevention in several SSA countries.
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Affiliation(s)
- Mohamed Hamidouche
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Pearl Anne Ante-Testard
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and STI Programmes, Geneva, Switzerland
| | - Laura Temime
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
| | - Kevin Jean
- Laboratoire MESuRS, Conservatoire national des Arts et Metiers
- Unité PACRI, Institut Pasteur, Conservatoire national des Arts et Métiers, Paris, France
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Facente SN, Grebe E, Maher AD, Fox D, Scheer S, Mahy M, Dalal S, Lowrance D, Marsh K. Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review. JMIR Public Health Surveill 2022; 8:e34410. [PMID: 35275085 PMCID: PMC8956992 DOI: 10.2196/34410] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Accepted: 02/02/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND HIV assays designed to detect recent infection, also known as "recency assays," are often used to estimate HIV incidence in a specific country, region, or subpopulation, alone or as part of recent infection testing algorithms (RITAs). Recently, many countries and organizations have become interested in using recency assays within case surveillance systems and routine HIV testing services to measure other indicators beyond incidence, generally referred to as "non-incidence surveillance use cases." OBJECTIVE This review aims to identify published evidence that can be used to validate methodological approaches to recency-based incidence estimation and non-incidence use cases. The evidence identified through this review will be used in the forthcoming technical guidance by the World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) on the use of HIV recency assays for identification of epidemic trends, whether for HIV incidence estimation or non-incidence indicators of recency. METHODS To identify the best methodological and field implementation practices for the use of recency assays to estimate HIV incidence and trends in recent infections for specific populations or geographic areas, we conducted a systematic review of the literature to (1) understand the use of recency testing for surveillance in programmatic and laboratory settings, (2) review methodologies for implementing recency testing for both incidence estimation and non-incidence use cases, and (3) assess the field performance characteristics of commercially available recency assays. RESULTS Among the 167 documents included in the final review, 91 (54.5%) focused on assay or algorithm performance or methodological descriptions, with high-quality evidence of accurate age- and sex-disaggregated HIV incidence estimation at national or regional levels in general population settings, but not at finer geographic levels for prevention prioritization. The remaining 76 (45.5%) described the field use of incidence assays including field-derived incidence (n=45), non-incidence (n=25), and both incidence and non-incidence use cases (n=6). The field use of incidence assays included integrating RITAs into routine surveillance and assisting with molecular genetic analyses, but evidence was generally weaker or only reported on what was done, without validation data or findings related to effectiveness of using non-incidence indicators calculated through the use of recency assays as a proxy for HIV incidence. CONCLUSIONS HIV recency assays have been widely validated for estimating HIV incidence in age- and sex-specific populations at national and subnational regional levels; however, there is a lack of evidence validating the accuracy and effectiveness of using recency assays to identify epidemic trends in non-incidence surveillance use cases. More research is needed to validate the use of recency assays within HIV testing services, to ensure findings can be accurately interpreted to guide prioritization of public health programming.
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Affiliation(s)
- Shelley N Facente
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States.,Facente Consulting, Richmond, CA, United States.,Vitalant Research Institute, San Francisco, CA, United States
| | - Eduard Grebe
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States.,Vitalant Research Institute, San Francisco, CA, United States.,South African Centre for Epidemiological Modeling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Andrew D Maher
- South African Centre for Epidemiological Modeling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Douglas Fox
- Facente Consulting, Richmond, CA, United States
| | | | - Mary Mahy
- Strategic Information Department, The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - David Lowrance
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - Kimberly Marsh
- Strategic Information Department, The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
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Jin H, Restar A, Beyrer C. Overview of the epidemiological conditions of HIV among key populations in Africa. J Int AIDS Soc 2021; 24 Suppl 3:e25716. [PMID: 34190412 PMCID: PMC8242974 DOI: 10.1002/jia2.25716] [Citation(s) in RCA: 15] [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: 10/22/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Despite extraordinary progress in HIV treatment coverage and expanding access to HIV prevention services and that multiple African countries are on track in their efforts to reach 90-90-90 goals, the epidemic continues to persist, with prevalence and incidence rates too high in some parts of the continent to achieve epidemic control. While data sources are improving, and research studies on key populations in specific contexts have improved, work on understanding the HIV burdens and barriers to services for these populations remains sparse, uneven and absent altogether in multiple settings. More data have become available in the last several years, and data published in 2010 or more recently are reviewed here for each key population. This scoping review assesses the current epidemiology of HIV among key populations in Africa and the social and political environments that contribute to the epidemic, both of which suggest that without significant policy reform, these epidemics will likely continue. RESULTS AND DISCUSSION Across Africa, the HIV epidemic is most severe among key populations including women and men who sell or trade sex, men who have sex with men, people who inject drugs, transgender women who have sex with men and prisoners and detainees. These groups account for the majority of new infections in West and Central Africa, and an estimated 25% of new infections in East and Southern Africa, despite representing relatively small proportions of those populations. The HIV literature in Africa emphasizes that despite significant health needs, key populations experience barriers to accessing services within the healthcare and legal justice systems. Current shortcomings of surveillance systems in enumerating key populations impact the way funding mechanisms and resources are allocated and distributed. Adapting more equitable and epidemiologically sound frameworks will be necessary for current and future HIV programming investments. CONCLUSIONS Through this review, the available literature on HIV epidemiology among key populations in Africa brings to light a number of surveillance, programmatic and research gaps. For many communities, interventions targeting the health and security conditions continue to be minimal. Compelling evidence suggests that sweeping policy and programmatic changes are needed to effectively tackle the persistent HIV epidemic in Africa.
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Affiliation(s)
- Harry Jin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health
| | - Arjee Restar
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health
| | - Chris Beyrer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health
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Chauhan CK, Lakshmi PVM, Sagar V, Sharma A, Arora SK, Kumar R. Immunological markers for identifying recent HIV infection in North-West India. Indian J Med Res 2021; 152:227-233. [PMID: 33107482 PMCID: PMC7881826 DOI: 10.4103/ijmr.ijmr_2007_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Being more efficient and widely used, limiting antigen (LAg)-avidity enzyme immunoassay (EIA) based on the recent infection testing algorithm (RITA) has been developed for differentiating recent and established HIV-1 infection. So far, LAg-avidity EIA has not been validated among the Indian population. Hence, the present study was planned to identify recent HIV infections in high risk patients in the North-West region of India using modified LAg-avidity RITA. Methods Four hundred HIV-positive high risk patients registered on pre-antiretroviral therapy (ART) programme in the last one year, from five ART centres in North-Western States of India, were included for identifying the recent HIV infections. One hundred HIV-positive cases registered for pre-ART for greater than two years in ART centres were included for estimating false recent rate (FRR). Single-well LAg-avidity EIA-based modified RITA was used to identify recent HIV infection cases. Results Of the 400 HIV-1-positive samples, 64 (16%) were found to have been infected within the past 130 days. The proportion of recent HIV infections was 16.8 per cent (18/107) among female sex workers, 10.7 per cent (9/84) among men who have sex with men and 17.7 per cent (37/209) among injecting drug users. The FRR was one per cent (1/100). Interpretation & conclusions LAg-avidity EIA-based modified RITA provided good discrimination between recent and non-recent HIV infection, hence, it could be considered suitable for estimating HIV incidence in sentinel surveillance system in India.
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Affiliation(s)
- Chandar Kanta Chauhan
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Vivek Sagar
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunil K Arora
- Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Kumar
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Odwee A, Kasozi KI, Acup CA, Kyamanywa P, Ssebuufu R, Obura R, Agaba JB, Makeri D, Kirimuhuzya C, Sasirabo O, Bamaiyi PH. Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda. Afr Health Sci 2020; 20:122-131. [PMID: 33402900 PMCID: PMC7750061 DOI: 10.4314/ahs.v20i1.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients. METHODS A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors. RESULTS The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 - 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition. DISCUSSION In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities. CONCLUSIONS Malnutrition is a threat in HIV adult patients in rural communities of Uganda.
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Affiliation(s)
- Ambrose Odwee
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Keneth Iceland Kasozi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Christine Amongi Acup
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Richard Obura
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Jude B Agaba
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Danladi Makeri
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology, School of Pharmacy, Kampala International University Western Campus, Box 71 Bushenyi, Uganda
- Department of Pharmacology, School of Medicine, Kabale University, Kabale, Uganda
| | - Olivia Sasirabo
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Pwaveno H Bamaiyi
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Postgraduate School and Research Directorate, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Jos, Plateau State, Nigeria
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Alex D, Raj Williams TI, Sachithanandham J, Prasannakumar S, Demosthenes JP, Ramalingam VV, Victor PJ, Rupali P, Fletcher GJ, Kannangai R. Performance of a Modified In-House HIV-1 Avidity Assay among a Cohort of Newly Diagnosed HIV-1 Infected Individuals and the Effect of ART on the Maturation of HIV-1 Specific Antibodies. Curr HIV Res 2020; 17:134-145. [PMID: 31309891 DOI: 10.2174/1570162x17666190712125606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Viral kinetics impact humoral immune response to HIV; antibody avidity testing helps distinguish recent (<6 months) and long-term HIV infection. This study aims to determine the frequency of recent HIV-1 infection among clients attending ICTC (Integrated Counselling and Testing Centre) using a commercial EIA, to correlate it with a modified in-house avidity assay and to study the impact of ART on anti-HIV-1 antibody maturation. METHODS Commercial LAg Avidity EIA was used to detect antibody avidity among 117 treatment naïve HIV-1 infected individuals. A second-generation HIV ELISA was modified for in-house antibody avidity testing and cutoff was set based on Receiver Operating Characteristic (ROC) analysis. Archived paired samples from 25 HIV-1 infected individuals before ART and after successful ART; samples from 7 individuals responding to ART and during virological failure were also tested by LAg Avidity EIA. RESULTS Six individuals (5.1%) were identified as recently infected by a combination of LAg avidity assay and HIV-1 viral load testing. The modified in-house avidity assay demonstrated sensitivity and specificity of 100% and 98.2%, respectively, at AI=0.69 by ROC analysis. Median ODn values of individuals when responding to ART were significantly lower than pre-ART [4.136 (IQR 3.437- 4.827) vs 4.455 (IQR 3.748-5.120), p=0.006] whereas ODn values were higher during virological failure [4.260 (IQR 3.665 - 4.515) vs 2.868 (IQR 2.247 - 3.921), p=0.16]. CONCLUSION This modified in-house antibody avidity assay is an inexpensive method to detect recent HIV-1 infection. ART demonstrated significant effect on HIV-1 antibody avidity owing to changes in viral kinetics.
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Affiliation(s)
- Diviya Alex
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | | | | | - John Paul Demosthenes
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Punitha John Victor
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, 632004, India
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Mahy M, Marsh K, Sabin K, Wanyeki I, Daher J, Ghys PD. HIV estimates through 2018: data for decision-making. AIDS 2019; 33 Suppl 3:S203-S211. [PMID: 31343430 PMCID: PMC6919227 DOI: 10.1097/qad.0000000000002321] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Global targets call for a 75% reduction in new HIV infections and AIDS deaths between 2010 and 2020. UNAIDS supports countries to measure progress towards these targets. In 2019, this effort resulted in revised national, regional and global estimates reflecting the best available data. METHODS Spectrum software was used to develop estimates for 170 countries. Country teams from 151 countries developed HIV estimates directly and estimates for an additional 19 country were developed by UNAIDS based on available evidence. 107 countries employed models using HIV prevalence data from sentinel surveillance, routinely collected HIV testing and household surveys while the remaining 63 countries applied models using HIV case surveillance and/or reported AIDS deaths. Model parameters were informed by the UNAIDS Reference Group on Estimates, Modeling and Projections. RESULTS HIV estimates were available for 170 countries representing 99% of the global population. An estimated 37.9 million (uncertainty bounds 32.7-44.0 million) people were living with HIV in 2018. There were 1.7 million (1.4-2.3 million) new infections and 770 000 (570 000-1.1 million) AIDS-related deaths. New HIV infections declined in five of eight regions and AIDS deaths were declining in six of eight regions between 2010 and 2018. CONCLUSION The estimates demonstrate progress towards ending the AIDS epidemic by 2030, however, through 2018 declines in new HIV infections and AIDS-related deaths were not sufficient to meet global interim targets. The UNAIDS estimates have made important contributions to guide decisions about the HIV response at global, regional and country level.
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12
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Chapin-Bardales J, Masciotra S, Smith A, Hoots BE, Martin A, Switzer WM, Luo W, Owen SM, Paz-Bailey G. Characteristics of Persons Who Inject Drugs with Recent HIV Infection in the United States: National HIV Behavioral Surveillance, 2012. AIDS Behav 2019; 23:3277-3285. [PMID: 30778809 DOI: 10.1007/s10461-019-02420-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We evaluated characteristics associated with recent HIV infection among persons who inject drugs (PWID) from 19 U.S. cities who participated in 2012 National HIV Behavioral Surveillance. Recent infection was defined as having a reactive HIV test, a Bio-Rad Avidity index cutoff ≤ 30%, no reported HIV diagnosis ≥ 12 months before interview, and no evidence of viral suppression. Of 8667 PWID, 50 (0.6%) were recently HIV infected. Having a greater number of sex partners (≥ 2 partners vs. 0) [prevalence ratio (PR) 4.7, 95% confidence interval (CI) 1.3-17.8], injecting heroin and other drugs (PR 3.0, 95% CI 1.3-6.6) or exclusively non-heroin drugs (PR 5.9, 95% CI 1.7-20.7) compared to injecting only heroin, and having male-male sex in the past year (PR 7.1, 95% CI 3.0-16.6) were associated with recent infection. Promoting not only safe injection practices but also safe sex practices will be key to preventing new HIV infections.
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13
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Gonese E, Kilmarx PH, van Schalkwyk C, Grebe E, Mutasa K, Ntozini R, Parekh B, Dobbs T, Pottinger YD, Masciotra S, Owen M, Nachega JB, van Zyl G, Hargrove JW. Evaluation of the Performance of Three Biomarker Assays for Recent HIV Infection Using a Well-Characterized HIV-1 Subtype C Incidence Cohort. AIDS Res Hum Retroviruses 2019; 35:615-627. [PMID: 30938164 PMCID: PMC10719552 DOI: 10.1089/aid.2019.0033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Biomarkers for detecting early HIV infection and estimating HIV incidence should minimize false-recent rates (FRRs) while maximizing mean duration of recent infection (MDRI). We compared HIV subtypes B, E and D (BED) capture enzyme immunoassay (BED), Sedia limiting antigen (LAg) avidity enzyme immunoassay, and Bio-Rad avidity incidence (BRAI) assays using samples from Zimbabwean postpartum women infected with clade C HIV. We calculated MDRIs using 590 samples from 351 seroconverting postpartum women, and FRRs using samples from 2,825 women known to be HIV positive for >12 months. Antibody kinetics were more predictable with LAg and had higher precision compared with BED or BRAI. BRAI also exhibited more variability, and avidity reversal in some cases. For BED, LAg, and BRAI, used alone or with viral load, MDRI values in days were: BED-188 and 170 at normalized optical density (ODn) 0.8; LAg-104 and 100 at ODn cutoff 1.5; BRAI-135 and 134 at avidity index cutoff 30%. Corresponding FRRs were: BRAI 1.1% and 1.0% and LAg 0.57% and 0.35%: these were 3.8-10.9 times lower than BED values of 4.8% and 3.8%. BRAI and LAg have significantly lower FRRs and MDRIs than in published studies, and much lower than BED and could be used to estimate incidence in perinatal women and to measure population-level HIV incidence in HIV control operations in Africa.
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Affiliation(s)
- Elizabeth Gonese
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Harare, Zimbabwe
- DST-NRF Center of Excellence in Epidemiological Modeling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Peter H. Kilmarx
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Harare, Zimbabwe
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cari van Schalkwyk
- DST-NRF Center of Excellence in Epidemiological Modeling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Eduard Grebe
- DST-NRF Center of Excellence in Epidemiological Modeling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Kuda Mutasa
- Department of Laboratory Services, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Department of Laboratory Services, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bharat Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trudy Dobbs
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yen Duong Pottinger
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Laboratory Services, ICAP at University of Columbia, Mailman Public Health, Baltimore, Maryland
| | - Silvina Masciotra
- Department of Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michele Owen
- Department of Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean B. Nachega
- Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
- Department of Medicine and Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gert van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Cape Town, South Africa
| | - John W. Hargrove
- DST-NRF Center of Excellence in Epidemiological Modeling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
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14
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Silhol R, Gregson S, Nyamukapa C, Mhangara M, Dzangare J, Gonese E, Eaton JW, Case KK, Mahy M, Stover J, Mugurungi O. Empirical validation of the UNAIDS Spectrum model for subnational HIV estimates: case-study of children and adults in Manicaland, Zimbabwe. AIDS 2017; 31 Suppl 1:S41-S50. [PMID: 28296799 PMCID: PMC10660499 DOI: 10.1097/qad.0000000000001418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND More cost-effective HIV control may be achieved by targeting geographical areas with high infection rates. The AIDS Impact model of Spectrum - used routinely to produce national HIV estimates - could provide the required subnational estimates but is rarely validated with empirical data, even at a national level. DESIGN The validity of the Spectrum model estimates were compared with empirical estimates. METHODS Antenatal surveillance and population survey data from a population HIV cohort study in Manicaland, East Zimbabwe, were input into Spectrum 5.441 to create a simulation representative of the cohort population. Model and empirical estimates were compared for key demographic and epidemiological outcomes. Alternative scenarios for data availability were examined and sensitivity analyses were conducted for model assumptions considered important for subnational estimates. RESULTS Spectrum estimates generally agreed with observed data but HIV incidence estimates were higher than empirical estimates, whereas estimates of early age all-cause adult mortality were lower. Child HIV prevalence estimates matched well with the survey prevalence among children. Estimated paternal orphanhood was lower than empirical estimates. Including observations from earlier in the epidemic did not improve the HIV incidence model fit. Migration had little effect on observed discrepancies - possibly because the model ignores differences in HIV prevalence between migrants and residents. CONCLUSION The Spectrum model, using subnational surveillance and population data, provided reasonable subnational estimates although some discrepancies were noted. Differences in HIV prevalence between migrants and residents may need to be captured in the model if applied to subnational epidemics.
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Affiliation(s)
- Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Avondale, Harare, Zimbabwe
| | - Mutsa Mhangara
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Janet Dzangare
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Elizabeth Gonese
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Jeffrey W. Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Kelsey K. Case
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Mary Mahy
- Programme Branch, UNAIDS, Geneva, Switzerland
| | - John Stover
- Avenir Health, Glastonbury, Connecticut, USA
| | - Owen Mugurungi
- AIDS and TB Unit, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
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15
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Kiwanuka N, Ssetaala A, Ssekandi I, Nalutaaya A, Kitandwe PK, Ssempiira J, Bagaya BS, Balyegisawa A, Kaleebu P, Hahn J, Lindan C, Sewankambo NK. Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda. PLoS One 2017; 12:e0171200. [PMID: 28207844 PMCID: PMC5313154 DOI: 10.1371/journal.pone.0171200] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background Although the association between alcohol consumption and HIV risk is well documented, few studies have examined the magnitude of new HIV infections that could be prevented by controlling alcohol use. We report the population attributable fraction (PAF) of incident HIV infections due to alcohol consumption among the HIV high-risk population of fishing communities along Lake Victoria, Uganda. Methods In a community-based cohort study, 1607 HIV sero-negative participants aged 18–49 years were enrolled from eight fishing communities along Lake Victoria, Uganda. At follow up 12 months later, 1288 (80.1%) were seen and interviewed. At baseline and follow-up visits, participants completed interviewer-administered questionnaires on alcohol consumption, demographics, and sexual risk behavior, and were tested for HIV infection. HIV incidence and adjusted incident rate ratios (adjusted IRRs) were estimated using Poisson regression models; the crude and adjusted PAFs of incident HIV infections associated with alcohol consumption were calculated using the Greenland and Drescher method for cohort studies. Results Among the 1288 participants seen at follow up, 53.5% reported drinking alcohol of whom 24.4% drank occasionally (2 days a week or less) and 29.1% drank regularly (3–7 days a week). Forty eight incident HIV infections occurred giving an incidence rate of 3.39/100 person years at-risk (pyar) (95% CI, 2.55–4.49). Compared to non-drinkers, the adjusted IRR of HIV was 3.09 (1.13–8.46) among occasional drinkers and 5.34 (2.04–13.97) among regular drinkers. The overall adjusted PAF of incident HIV infections due alcohol was 64.1 (95% CI; 23.5–83.1); ranging from 52.3 (11.9–74.2) among Muslims to 71.2 (32.6–87.7) for participants who reported ≥ 2 sexual partners in the past 12 months. Conclusion In fishing communities along Lake Victoria, Uganda, 64% of new HIV infections can be attributed to drinking alcohol. Interventions to reduce alcohol consumption should be integrated in HIV/AIDS prevention activities for populations in whom both HIV and alcohol consumption are highly prevalent.
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Affiliation(s)
- Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
- * E-mail:
| | - Ali Ssetaala
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
| | - Ismail Ssekandi
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
| | - Annet Nalutaaya
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
| | - Paul Kato Kitandwe
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
| | - Julius Ssempiira
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
| | - Bernard Ssentalo Bagaya
- Uganda Virus Research Institute-International AIDS Vaccine Initiative HIV Vaccine Program, Entebbe, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
| | - Apolo Balyegisawa
- International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Insitute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Judith Hahn
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Christina Lindan
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Nelson Kaulukusi Sewankambo
- Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda
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16
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Moyo S, Wilkinson E, Vandormael A, Wang R, Weng J, Kotokwe KP, Gaseitsiwe S, Musonda R, Makhema J, Essex M, Engelbrecht S, de Oliveira T, Novitsky V. Pairwise diversity and tMRCA as potential markers for HIV infection recency. Medicine (Baltimore) 2017; 96:e6041. [PMID: 28178146 PMCID: PMC5313003 DOI: 10.1097/md.0000000000006041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intrahost human immunodeficiency virus (HIV)-1 diversity increases linearly over time. We assessed the extent to which mean pairwise distances and the time to the most recent common ancestor (tMRCA) inferred from intrahost HIV-1C env sequences were associated with the estimated time of HIV infection. Data from a primary HIV-1C infection study in Botswana were used for this analysis (N = 42). A total of 2540 HIV-1C env gp120 variable loop region 1 to conserved region 5 (V1C5) of the HIV-1 envelope gp120 viral sequences were generated by single genome amplification and sequencing, with an average of 61 viral sequences per participant and 11 sequences per time point per participant. Raw pairwise distances were calculated for each time point and participant using the ape package in R software. The tMRCA was estimated using phylogenetic inference implemented in Bayesian Evolutionary Analysis by Sampling Trees v1.8.2. Pairwise distances and tMRCA were significantly associated with the estimated time since HIV infection (both P < 0.001). Taking into account multiplicity of HIV infection strengthened these associations. HIV-1C env-based pairwise distances and tMRCA can be used as potential markers for HIV recency. However, the tMRCA estimates demonstrated no advantage over the pairwise distances estimates.
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Affiliation(s)
- Sikhulile Moyo
- Division of Medical Virology, Stellenbosch University, Tygerberg, South Africa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Eduan Wilkinson
- College of Health Sciences, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Alain Vandormael
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Rui Wang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jia Weng
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Simani Gaseitsiwe
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rosemary Musonda
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Max Essex
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory Services (NHLS), Tygerberg Coastal, South Africa
| | - Tulio de Oliveira
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Republic of South Africa
- Research Department of Infection, University College London, London, United Kingdom
- College of Health Sciences, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Vladimir Novitsky
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mahy M, Brown T, Stover J, Walker N, Stanecki K, Kirungi W, Garcia-Calleja T, Ghys PD. Producing HIV estimates: from global advocacy to country planning and impact measurement. Glob Health Action 2017; 10:1291169. [PMID: 28532304 PMCID: PMC5645679 DOI: 10.1080/16549716.2017.1291169] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/02/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The development of global HIV estimates has been critical for understanding, advocating for and funding the HIV response. The process of generating HIV estimates has been cited as the gold standard for public health estimates. OBJECTIVE This paper provides important lessons from an international scientific collaboration and provides a useful model for those producing public health estimates in other fields. DESIGN Through the compilation and review of published journal articles, United Nations reports, other documents and personal experience we compiled historical information about the estimates and identified potential lessons for other public health estimation efforts. RESULTS Through the development of core partnerships with country teams, implementers, demographers, mathematicians, epidemiologists and international organizations, UNAIDS has led a process to develop the capacity of country teams to produce internationally comparable HIV estimates. The guidance provided by these experts has led to refinements in the estimated numbers of people living with HIV, new HIV infections and AIDS-related deaths over the past 20 years. A number of important updates to the methods since 1997 resulted in fluctuations in the estimated levels, trends and impact of HIV. The largest correction occurred between the 2005 and 2007 rounds with the additions of household survey data into the models. In 2001 the UNAIDS models at that time estimated there were 40 million people living with HIV. In 2016, improved models estimate there were 30 million (27.6-32.7 million) people living with HIV in 2001. CONCLUSIONS Country ownership of the estimation tools has allowed for additional uses of the results than had the results been produced by researchers or a team in Geneva. Guidance from a reference group and input from country teams have led to critical improvements in the models over time. Those changes have improved countries' and stakeholders' understanding of the HIV epidemic.
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Affiliation(s)
- Mary Mahy
- Strategic Information and Evaluation Department, UNAIDS, Geneva, Switzerland
| | | | | | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Peter D. Ghys
- Strategic Information and Evaluation Department, UNAIDS, Geneva, Switzerland
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18
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Moyo S, Kotokwe KP, Mohammed T, Boleo C, Mupfumi L, Chishala S, Tsalaile L, Bussmann H, Gaseitsiwe S, Musonda R, Makhema J, Baum M, Marlink R, Engelbrecht S, Essex M, Novitsky V. Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana. AIDS Res Hum Retroviruses 2017; 33:17-18. [PMID: 27481530 DOI: 10.1089/aid.2016.0127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Cross-sectional estimation of HIV incidence could misclassify some established or chronic HIV infections as recent. Usually long-term nonprogressors, elite and viremic controllers, and individuals on ART contribute to misclassification. Local data on the false recent rate (FRR) could minimize misclassification during estimation of HIV incidence. To improve monitoring of HIV incidence, we estimated local FRR in Botswana. A total of 1,036 specimens from individuals infected for at least 1.5-2 years were sampled between 2004 and 2009 and tested using the limiting antigen (LAg)-avidity assay using a cutoff of 1.5 normalized optical density units. The FRR was 0.97% (10/1,036; 95% confidence interval [CI] 0.46-1.77). Four samples had HIV-1 RNA >1,000 cps/ml, giving an adjusted FRR of 0.39% (4/1,036; 95% CI 0.11-0.99). A combination of LAg and HIV-1 RNA load data resulted in FRR below 1% in the Botswana population.
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Affiliation(s)
- Sikhulile Moyo
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | | | | | | | - Lucy Mupfumi
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Samuel Chishala
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory, Ministry of Health, Gaborone, Botswana
| | - Lesedi Tsalaile
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Hermann Bussmann
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Joseph Makhema
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Marianna Baum
- Florida International University, College of Health and Urban Affairs, Miami, Florida
| | - Richard Marlink
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Susan Engelbrecht
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory Services (NHLS), Tygerberg Coastal, South Africa
| | - Max Essex
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vladimir Novitsky
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Viral and Host Characteristics of Recent and Established HIV-1 Infections in Kisumu based on a Multiassay Approach. Sci Rep 2016; 6:37964. [PMID: 27897226 PMCID: PMC5126579 DOI: 10.1038/srep37964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022] Open
Abstract
Integrated approaches provide better understanding of HIV/AIDS epidemics. We optimised a multiassay algorithm (MAA) and assessed HIV incidence, correlates of recent infections, viral diversity, plus transmission clusters among participants screened for Kisumu Incidence Cohort Study (KICoS1) (2007–2009). We performed BED-CEIA, Limiting antigen (LAg) avidity, Biorad avidity, and viral load (VL) tests on HIV-positive samples. Genotypic analyses focused on HIV-1 pol gene. Correlates of testing recent by MAA were assessed using logistic regression model. Overall, 133 (12%, 95% CI: 10.2–14.1) participants were HIV-positive, of whom 11 tested recent by MAA (BED-CEIA OD-n < 0.8 + LAg avidity OD-n < 1.5 + VL > 1000 copies/mL), giving an incidence of 1.46% (95% CI: 0.58–2.35) per year. This MAA-based incidence was similar to longitudinal KICoS1 incidence. Correlates of testing recent included sexually transmitted infection (STI) treatment history (OR = 3.94, 95% CI: 1.03–15.07) and syphilis seropositivity (OR = 10.15, 95% CI: 1.51–68.22). Overall, HIV-1 subtype A (63%), D (15%), C (3%), G (1%) and recombinants (18%), two monophyletic dyads and intrinsic viral mutations (V81I, V81I/V, V108I/V and K101Q) were observed. Viral diversity mirrored known patterns in this region, while resistance mutations reflected likely non-exposure to antiretroviral drugs. Management of STIs may help address ongoing HIV transmission in this region.
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20
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Moyo S, Vandormael A, Wilkinson E, Engelbrecht S, Gaseitsiwe S, Kotokwe KP, Musonda R, Tanser F, Essex M, Novitsky V, de Oliveira T. Analysis of Viral Diversity in Relation to the Recency of HIV-1C Infection in Botswana. PLoS One 2016; 11:e0160649. [PMID: 27552218 PMCID: PMC4994946 DOI: 10.1371/journal.pone.0160649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/23/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cross-sectional, biomarker methods to determine HIV infection recency present a promising and cost-effective alternative to the repeated testing of uninfected individuals. We evaluate a viral-based assay that uses a measure of pairwise distances (PwD) to identify HIV infection recency, and compare its performance with two serologic incidence assays, BED and LAg. In addition, we assess whether combination BED plus PwD or LAg plus PwD screening can improve predictive accuracy by reducing the likelihood of a false-recent result. METHODS The data comes from 854 time-points and 42 participants enrolled in a primary HIV-1C infection study in Botswana. Time points after treatment initiation or with evidence of multiplicity of infection were excluded from the final analysis. PwD was calculated from quasispecies generated using single genome amplification and sequencing. We evaluated the ability of PwD to correctly classify HIV infection recency within <130, <180 and <360 days post-seroconversion using Receiver Operator Characteristics (ROC) methods. Following a secondary PwD screening, we quantified the reduction in the relative false-recency rate (rFRR) of the BED and LAg assays while maintaining a sensitivity of either 75, 80, 85 or 90%. RESULTS The final analytic sample consisted of 758 time-points from 40 participants. The PwD assay was more accurate in classifying infection recency for the 130 and 180-day cut-offs when compared with the recommended LAg and BED thresholds. A higher AUC statistic confirmed the superior predictive performance of the PwD assay for the three cut-offs. When used for combination screening, the PwD assay reduced the rFRR of the LAg assay by 52% and the BED assay by 57.8% while maintaining a 90% sensitivity for the 130 and 180-day cut-offs respectively. CONCLUSION PwD can accurately determine HIV infection recency. A secondary PwD screening reduces misclassification and increases the accuracy of serologic-based assays.
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Affiliation(s)
- Sikhulile Moyo
- Division of Medical Virology, Stellenbosch University, Tygerberg, South Africa
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- * E-mail:
| | - Alain Vandormael
- Wellcome Trust Africa Centre for Health and Population Studies, Dorris Duke Medical Research Centre, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Eduan Wilkinson
- Wellcome Trust Africa Centre for Health and Population Studies, Dorris Duke Medical Research Centre, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University, Tygerberg, South Africa
- National Health Laboratory Services (NHLS), Tygerberg Coastal, South Africa
| | - Simani Gaseitsiwe
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Rosemary Musonda
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank Tanser
- Wellcome Trust Africa Centre for Health and Population Studies, Dorris Duke Medical Research Centre, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Max Essex
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Vladimir Novitsky
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Tulio de Oliveira
- Wellcome Trust Africa Centre for Health and Population Studies, Dorris Duke Medical Research Centre, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Research Department of Infection, University College London, London, United Kingdom
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Buthelezi UE, Davidson CL, Kharsany ABM. Strengthening HIV surveillance: measurements to track the epidemic in real time. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2016; 15:89-98. [PMID: 27399039 PMCID: PMC5547190 DOI: 10.2989/16085906.2016.1196223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Surveillance for HIV as a public health initiative requires timely, detailed and robust data to systematically understand burden of infection, transmission patterns, direct prevention efforts, guide funding, identify new infections and predict future trends in the epidemic. The methods for HIV surveillance have evolved to reliably track the epidemic and identify new infections in real time. Initially HIV surveillance relied primarily on the reporting of AIDS cases followed by measuring antibodies to HIV to determine prevalence in key populations. With the roll-out of antiretroviral therapy (ART) resulting in better survival and the corresponding increase in HIV prevalence, the landscape of surveillance shifted further to track HIV prevalence and incidence within the context of programmes. Recent developments in laboratory assays that potentially measure and differentiate recent versus established HIV infection offer a cost-effective method for the rapid estimation of HIV incidence. These tests continue to be validated and are increasingly useful in informing the status of the epidemic in real time. Surveillance of heterogeneity of infections contributing to sub-epidemics requires methods to identify affected populations, density, key geographical locations and phylogenetically linked or clustered infections. Such methods could provide a nuanced understanding of the epidemic and prioritise prevention efforts to those most vulnerable. This paper brings together recent developments and challenges facing HIV surveillance, together with the application of newer assays and methods to fast-track the HIV prevention and treatment response.
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Affiliation(s)
- Usangiphile E Buthelezi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - Candace L Davidson
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - Ayesha BM Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal
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Kim AA, Parekh BS, Umuro M, Galgalo T, Bunnell R, Makokha E, Dobbs T, Murithi P, Muraguri N, De Cock KM, Mermin J. Identifying Risk Factors for Recent HIV Infection in Kenya Using a Recent Infection Testing Algorithm: Results from a Nationally Representative Population-Based Survey. PLoS One 2016; 11:e0155498. [PMID: 27195800 PMCID: PMC4873043 DOI: 10.1371/journal.pone.0155498] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/01/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION A recent infection testing algorithm (RITA) that can distinguish recent from long-standing HIV infection can be applied to nationally representative population-based surveys to characterize and identify risk factors for recent infection in a country. MATERIALS AND METHODS We applied a RITA using the Limiting Antigen Avidity Enzyme Immunoassay (LAg) on stored HIV-positive samples from the 2007 Kenya AIDS Indicator Survey. The case definition for recent infection included testing recent on LAg and having no evidence of antiretroviral therapy use. Multivariate analysis was conducted to determine factors associated with recent and long-standing infection compared to HIV-uninfected persons. All estimates were weighted to adjust for sampling probability and nonresponse. RESULTS Of 1,025 HIV-antibody-positive specimens, 64 (6.2%) met the case definition for recent infection and 961 (93.8%) met the case definition for long-standing infection. Compared to HIV-uninfected individuals, factors associated with higher adjusted odds of recent infection were living in Nairobi (adjusted odds ratio [AOR] 11.37; confidence interval [CI] 2.64-48.87) and Nyanza (AOR 4.55; CI 1.39-14.89) provinces compared to Western province; being widowed (AOR 8.04; CI 1.42-45.50) or currently married (AOR 6.42; CI 1.55-26.58) compared to being never married; having had ≥ 2 sexual partners in the last year (AOR 2.86; CI 1.51-5.41); not using a condom at last sex in the past year (AOR 1.61; CI 1.34-1.93); reporting a sexually transmitted infection (STI) diagnosis or symptoms of STI in the past year (AOR 1.97; CI 1.05-8.37); and being aged <30 years with: 1) HSV-2 infection (AOR 8.84; CI 2.62-29.85), 2) male genital ulcer disease (AOR 8.70; CI 2.36-32.08), or 3) lack of male circumcision (AOR 17.83; CI 2.19-144.90). Compared to HIV-uninfected persons, factors associated with higher adjusted odds of long-standing infection included living in Coast (AOR 1.55; CI 1.04-2.32) and Nyanza (AOR 2.33; CI 1.67-3.25) provinces compared to Western province; being separated/divorced (AOR 1.87; CI 1.16-3.01) or widowed (AOR 2.83; CI 1.78-4.45) compared to being never married; having ever used a condom (AOR 1.61; CI 1.34-1.93); and having a STI diagnosis or symptoms of STI in the past year (AOR 1.89; CI 1.20-2.97). Factors associated with lower adjusted odds of long-standing infection included using a condom at last sex in the past year (AOR 0.47; CI 0.36-0.61), having no HSV2-infection at aged <30 years (AOR 0.38; CI 0.20-0.75) or being an uncircumcised male aged <30 years (AOR 0.30; CI 0.15-0.61). CONCLUSION We identified factors associated with increased risk of recent and longstanding HIV infection using a RITA applied to blood specimens collected in a nationally representative survey. Though some false-recent cases may have been present in our sample, the correlates of recent infection identified were epidemiologically and biologically plausible. These methods can be used as a model for other countries with similar epidemics to inform targeted combination prevention strategies aimed to drastically decrease new infections in the population.
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Affiliation(s)
- Andrea A. Kim
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV and Tuberculosis (DGHT), Nairobi, Kenya
| | | | - Mamo Umuro
- Kenya Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Tura Galgalo
- Kenya Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Rebecca Bunnell
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV and Tuberculosis (DGHT), Nairobi, Kenya
| | - Ernest Makokha
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV and Tuberculosis (DGHT), Nairobi, Kenya
| | - Trudy Dobbs
- US CDC, CGH, DGHT, Atlanta, Georgia, United States of America
| | - Patrick Murithi
- Kenya Ministry of Health, National AIDS Control Council, Nairobi, Kenya
| | - Nicholas Muraguri
- Kenya Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
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Epidemiological Trends for HIV in Southern Africa: Implications for Reaching the Elimination Targets. Curr HIV/AIDS Rep 2016; 12:196-206. [PMID: 25929961 DOI: 10.1007/s11904-015-0264-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Southern Africa is the region worst affected by HIV in the world and accounts for one third of the global burden of HIV. Achieving the UNAIDS 90-90-90 target by 2020 and ending the AIDS epidemic by 2030 depend on success in this region. We review epidemiological trends in each country in southern Africa with respect to the prevalence, incidence, mortality, coverage of anti-retroviral therapy (ART) and TB notification rates, to better understand progress in controlling HIV and TB and to determine what needs to be done to reach the UNAIDS targets. Significant progress has been made in controlling HIV. In all countries in the region, the prevalence of HIV in people not on ART, the incidence of HIV, AIDS-related mortality and, in most countries, TB notification rates, are falling. In some countries, the risk of infection began to fall before biomedical interventions such as ART became widely available as a result of effective prevention measures or people's awareness of, and response to, the epidemic but the reasons for these declines remain uncertain. Some countries have achieved better levels of ART coverage than others, but all are in a position to reach the 2020 and 2030 targets if they accelerate the roll-out of ART and of targeted prevention efforts. Achieving the HIV treatment targets will further reduce the incidence of HIV-related TB, but efforts to control TB in HIV-negative people must be improved and strengthened.
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Modelling the Age Dynamics of Chronic Health Conditions: Life-Table-Consistent Transition Probabilities and their Application. Can J Aging 2016; 34:176-93. [PMID: 25917602 DOI: 10.1017/s071498081500001x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Surveys of chronic health conditions provide information about prevalence but not incidence and the process of change within the population. Our study shows how "age dynamics" of chronic conditions – the probabilities of contracting conditions at different ages, of moving from one chronic condition state to another, and of dying – can be inferred from prevalence data for those conditions that can be viewed as irreversible. Transition probability matrices are constructed for successive age groups, with the sequence representing the age dynamics of the health conditions for a stationary population. We simulate the life path of a cohort under the initial probabilities, and again under altered probabilities, to explore the effects of reducing the incidence or mortality rate associated with a particular condition. We show that such surveys of chronic conditions can be made even more valuable by allowing the calculation of the transition probabilities that define the chronic conditions aging process.
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Rehle T, Johnson L, Hallett T, Mahy M, Kim A, Odido H, Onoya D, Jooste S, Shisana O, Puren A, Parekh B, Stover J. A Comparison of South African National HIV Incidence Estimates: A Critical Appraisal of Different Methods. PLoS One 2015; 10:e0133255. [PMID: 26230949 PMCID: PMC4521952 DOI: 10.1371/journal.pone.0133255] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/25/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The interpretation of HIV prevalence trends is increasingly difficult as antiretroviral treatment programs expand. Reliable HIV incidence estimates are critical to monitoring transmission trends and guiding an effective national response to the epidemic. METHODS AND FINDINGS We used a range of methods to estimate HIV incidence in South Africa: (i) an incidence testing algorithm applying the Limiting-Antigen Avidity Assay (LAg-Avidity EIA) in combination with antiretroviral drug and HIV viral load testing; (ii) a modelling technique based on the synthetic cohort principle; and (iii) two dynamic mathematical models, the EPP/Spectrum model package and the Thembisa model. Overall, the different incidence estimation methods were in broad agreement on HIV incidence estimates among persons aged 15-49 years in 2012. The assay-based method produced slightly higher estimates of incidence, 1.72% (95% CI 1.38 - 2.06), compared with the mathematical models, 1.47% (95% CI 1.23 - 1.72) in Thembisa and 1.52% (95% CI 1.43 - 1.62) in EPP/Spectrum, and slightly lower estimates of incidence compared to the synthetic cohort, 1.9% (95% CI 0.8 - 3.1) over the period from 2008 to 2012. Among youth aged 15-24 years, a declining trend in HIV incidence was estimated by all three mathematical estimation methods. CONCLUSIONS The multi-method comparison showed similar levels and trends in HIV incidence and validated the estimates provided by the assay-based incidence testing algorithm. Our results confirm that South Africa is the country with the largest number of new HIV infections in the world, with about 1 000 new infections occurring each day among adults aged 15-49 years in 2012.
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Affiliation(s)
- Thomas Rehle
- Human Sciences Research Council, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Timothy Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | - Andrea Kim
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, GA, United States of America
| | | | - Dorina Onoya
- Human Sciences Research Council, Cape Town, South Africa
| | - Sean Jooste
- Human Sciences Research Council, Cape Town, South Africa
| | - Olive Shisana
- Human Sciences Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Adrian Puren
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Bharat Parekh
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, GA, United States of America
| | - John Stover
- Futures Institute, Glastonbury, CT, United States of America
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González R, Augusto OJ, Munguambe K, Pierrat C, Pedro EN, Sacoor C, De Lazzari E, Aponte JJ, Macete E, Alonso PL, Menendez C, Naniche D. HIV Incidence and Spatial Clustering in a Rural Area of Southern Mozambique. PLoS One 2015; 10:e0132053. [PMID: 26147473 PMCID: PMC4493140 DOI: 10.1371/journal.pone.0132053] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background Monitoring the HIV epidemic in a defined population is critical for planning treatment and preventive strategies. This is especially important in sub-Saharan Africa, which harbours the highest burden of the disease. Objective To estimate HIV incidence in adults aged 18-47 years old and to investigate spatial variations of HIV prevalence in Manhiça, a semi-rural area of southern Mozambique. Methods Two cross-sectional community-based surveys were conducted in 2010 and 2012 to determine HIV prevalence. Individual participants were randomly selected from the demographic surveillance system in place in the area and voluntary HIV counselling and testing was offered at the household level. HIV incidence was calculated using prevalence estimates from the two sero-surveys. Each participant’s household was geocoded using a global information system. The Spatial Scan Statistics programme was used to identify areas with disproportionate excess in HIV prevalence. Results A total of 1511 adults were tested. The estimated HIV prevalence in the community was 39.9% in 2010 and 39.7% in 2012. The overall HIV incidence was 3.6 new infections per 100 person-years at risk (PYAR) [95CI 1.56; 7.88], assuming stable epidemic conditions, and tended to be higher in women (4.9/100 PYAR [95CI 1.74; 11.85]) than in men (3.2/PYAR [95CI 1.36; 9.92]). One cluster with significant excess HIV prevalence was identified at the same geographic location in both surveys. This cluster had an HIV prevalence of 79.0% in 2010 and 52.3% in 2012. Conclusions The findings of these first individually-randomised community-HIV sero-surveys conducted in Mozambique reinforce the need to combine HIV incidence estimates and research on micro geographical infection patterns to guide and consolidate effective prevention strategies.
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Affiliation(s)
- Raquel González
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
- * E-mail:
| | | | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Charlotte Pierrat
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Elpidia N. Pedro
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Elisa De Lazzari
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - John J. Aponte
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
- Direcção Nacional de Saúde (DNS), Ministério da Saúde, Maputo, Mozambique
| | - Pedro L. Alonso
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
- World Health Organization (WHO), Geneva, Switzerland
| | - Clara Menendez
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
| | - Denise Naniche
- ISGlobal, Barcelona Ctr. Int. Heath Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique
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Longosz AF, Morrison CS, Chen PL, Brand HH, Arts E, Nankya I, Salata RA, Quinn TC, Eshleman SH, Laeyendecker O. Comparison of antibody responses to HIV infection in Ugandan women infected with HIV subtypes A and D. AIDS Res Hum Retroviruses 2015; 31:421-7. [PMID: 25317854 DOI: 10.1089/aid.2014.0081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We compared the serologic response to HIV infection in Ugandan women with HIV subtype A (N=82) and D (N=32) infection using a limiting antigen avidity assay (LAg-Avidity assay); 2,614 samples were analyzed. Study participants were followed a median of 6.6 years after HIV seroconversion. Samples were classified as assay positive if they had a LAg-Avidity assay result <1.5 normalized optical density units (OD-n). Women with subtype D infection were more likely to have delayed antibody maturation. During the first 2 years after seroconversion, the mean time that women had an assay-positive result (mean duration of recent infection, MDRI) was longer for women with subtype D infection than women with subtype A infection (267.9 days, 95% CI: 231.2-308.2 vs. 167.3 days, 95% CI: 151.8-185.9 days, p<0.01). The MDRI was also longer for women with subtype D infection after excluding low viral load samples and samples from women on antiretroviral therapy (ART). Women infected for >2 years were also more likely to be misclassified as recently infected in they had subtype D infection. Women with subtype D infection were also more likely to have antibody waning compared to women with subtype A infection. These findings may be related to the higher pathogenicity of subtype D HIV infection and are relevant to use of the LAg-Avidity assay for cross-sectional HIV incidence estimation in populations where subtype D infection is prevalent.
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Affiliation(s)
- Andrew F. Longosz
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland
| | | | | | - Hilmarie H. Brand
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Eric Arts
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Thomas C. Quinn
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Oliver Laeyendecker
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lindan CP, Anglemyer A, Hladik W, Barker J, Lubwama G, Rutherford G, Ssenkusu J, Opio A, Campbell J. High-risk motorcycle taxi drivers in the HIV/AIDS era: a respondent-driven sampling survey in Kampala, Uganda. Int J STD AIDS 2015; 26:336-45. [PMID: 24970473 PMCID: PMC6787404 DOI: 10.1177/0956462414538006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated motorcycle taxi ('boda-boda') drivers in Kampala for the prevalence of HIV/sexually transmitted infections. We used respondent-driven sampling to recruit a cross-sectional sample of boda-boda drivers. We collected data through audio computer-assisted self-administered interviews. Men were tested for HIV, syphilis serology using Rapid Plasma Reagin and enzyme immunoassay, and Chlamydia and gonorrhoea using urine polymerase chain reaction. We recruited 683 men. Median age was 26 years; 59.4% were single. The prevalence of HIV was 7.5% (95% CI 5.2-10.0), of positive syphilis serology was 6.1% (95% CI 4.3-8.1), of Chlamydia was 1.1% (95% CI 0.4-2.0), and of gonorrhoea was 1.2% (95% CI 0.1-1.2). Many men (67.8%) had both casual and regular partners, sex with other men (8.7%), and commercial sex (33.1%). Factors associated with having HIV included reporting a genital ulcer (odds ratio [OR] =2.4, 95% CI 1.4-4.4), drinking alcohol during last sex (OR 2.0, 95% CI 1.1-3.7), having 4-6 lifetime partners (OR 2.2, 95% CI 1.0-4.8), and having one's last female partner be >24 years of age (OR 2.8, 95% CI 1.2-6.6). Independent predictors of HIV included age ≥31 (adjusted OR (aOR) 5.8, 95% CI 1.5-48.5), having 4-6 partners (aOR 2.2, 95%CI 1.0-5.1), and self-report of a genital ulcer (OR 2.3, 95% CI 1.2-4.1). Only 39.2% of men were circumcised, and 36.9% had been HIV tested in the past. Male boda-boda drivers have a higher prevalence of HIV than the general population, and low frequency of preventive behaviours, such as circumcision and HIV testing. Targeted and intensified interventions for this group are warranted.
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Affiliation(s)
- Christina P Lindan
- Global Health Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Andrew Anglemyer
- Global Health Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Wolfgang Hladik
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph Barker
- Office of the Global AIDS Coordinator, US Department of State, Washington, DC, USA
| | - George Lubwama
- School of Public Health, Makerere University, Kampala, Uganda
| | - George Rutherford
- Global Health Sciences and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - John Ssenkusu
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Entebbe, Uganda
| | | | - James Campbell
- Department of Pediatrics, University of Maryland, Bethesda, MD, USA
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Duong YT, Kassanjee R, Welte A, Morgan M, De A, Dobbs T, Rottinghaus E, Nkengasong J, Curlin ME, Kittinunvorakoon C, Raengsakulrach B, Martin M, Choopanya K, Vanichseni S, Jiang Y, Qiu M, Yu H, Hao Y, Shah N, Le LV, Kim AA, Nguyen TA, Ampofo W, Parekh BS. Recalibration of the limiting antigen avidity EIA to determine mean duration of recent infection in divergent HIV-1 subtypes. PLoS One 2015; 10:e0114947. [PMID: 25710171 PMCID: PMC4339840 DOI: 10.1371/journal.pone.0114947] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background Mean duration of recent infection (MDRI) and misclassification of long-term HIV-1 infections, as proportion false recent (PFR), are critical parameters for laboratory-based assays for estimating HIV-1 incidence. Recent review of the data by us and others indicated that MDRI of LAg-Avidity EIA estimated previously required recalibration. We present here results of recalibration efforts using >250 seroconversion panels and multiple statistical methods to ensure accuracy and consensus. Methods A total of 2737 longitudinal specimens collected from 259 seroconverting individuals infected with diverse HIV-1 subtypes were tested with the LAg-Avidity EIA as previously described. Data were analyzed for determination of MDRI at ODn cutoffs of 1.0 to 2.0 using 7 statistical approaches and sub-analyzed by HIV-1 subtypes. In addition, 3740 specimens from individuals with infection >1 year, including 488 from patients with AIDS, were tested for PFR at varying cutoffs. Results Using different statistical methods, MDRI values ranged from 88–94 days at cutoff ODn = 1.0 to 177–183 days at ODn = 2.0. The MDRI values were similar by different methods suggesting coherence of different approaches. Testing for misclassification among long-term infections indicated that overall PFRs were 0.6% to 2.5% at increasing cutoffs of 1.0 to 2.0, respectively. Balancing the need for a longer MDRI and smaller PFR (<2.0%) suggests that a cutoff ODn = 1.5, corresponding to an MDRI of 130 days should be used for cross-sectional application. The MDRI varied among subtypes from 109 days (subtype A&D) to 152 days (subtype C). Conclusions Based on the new data and revised analysis, we recommend an ODn cutoff = 1.5 to classify recent and long-term infections, corresponding to an MDRI of 130 days (118–142). Determination of revised parameters for estimation of HIV-1 incidence should facilitate application of the LAg-Avidity EIA for worldwide use.
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Affiliation(s)
- Yen T. Duong
- International Laboratory Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Reshma Kassanjee
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa
- School of Computational and Applied Mathematics, University of the Witwatersrand, Johannesburg, South Africa
| | - Alex Welte
- The South African DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, Stellenbosch, South Africa
| | - Meade Morgan
- Epidemiology and Strategic Information Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anindya De
- Epidemiology and Strategic Information Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Trudy Dobbs
- International Laboratory Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Erin Rottinghaus
- International Laboratory Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Nkengasong
- International Laboratory Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marcel E. Curlin
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | | | | | - Michael Martin
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - Kachit Choopanya
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - Suphak Vanichseni
- Thailand Ministry of Public Health-US CDC Collaboration, Bangkok, Thailand
| | - Yan Jiang
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maofeng Qiu
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haiying Yu
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Hao
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Neha Shah
- California Department of Public Health, Richmond, California, United States of America
| | - Linh-Vi Le
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Hanoi, Vietnam
| | | | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Bharat S. Parekh
- International Laboratory Branch, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Kiwanuka N, Mpendo J, Nalutaaya A, Wambuzi M, Nanvubya A, Kitandwe PK, Muyanja E, Ssempiira J, Balyegisawa A, Ssetaala A. An assessment of fishing communities around Lake Victoria, Uganda, as potential populations for future HIV vaccine efficacy studies: an observational cohort study. BMC Public Health 2014; 14:986. [PMID: 25242015 PMCID: PMC4194358 DOI: 10.1186/1471-2458-14-986] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/18/2014] [Indexed: 12/20/2022] Open
Abstract
Background An effective HIV vaccine is still elusive. Of the 9 HIV preventive vaccine efficacy trials conducted to-date, only one reported positive results of modest efficacy. More efficacy trials need to be conducted before one or more vaccines are eventually licensed. We assessed the suitability of fishing communities in Uganda for future HIV vaccine efficacy trials. Methods A community-based cohort study was conducted among a random sample of 2191 participants aged 18–49 years. Data were collected on socio-demographic characteristics, HIV risky behaviors, and willingness to participate in future HIV vaccine trials (WTP). Venous blood was collected for HIV serological testing. Retention/follow rates and HIV incidence rates per 100 person years at-risk (pyar) were estimated. Adjusted prevalence proportion ratios (PPRs) of retention and odds ratios (ORs) of lack of WTP were estimated using log-binomial and logistic regression models respectively. Results Overall retention rate was 76.9% (1685/2191), highest (89%) among participants who had spent 5+ years in the community and lowest (54.1%) among those with <1 year stay. Significant predictors of retention included tribe/ethnicity, baseline HIV negative status, and longer than 1 year stay in the community. Overall WTP was 89.1% (1953/2191). Lack of WTP was significantly higher among women than men [adj.OR = 1.51 (95% CI, 1.14- 2.00)] and among participants who had stayed in fishing communities for 10 or more years relative to those with less than one year [adj.OR = 1.78 (95% CI, 1.11 - 2.88)]. Overall HIV incidence rate per 100 pyar was 3.39 (95% CI; 2.55 - 4.49). Participants aged 25–29 years had highest incidence rates (4.61 - 7.67/100 pyar) and high retention rates between 78.5 and 83.1%. In a combined analysis of retention and incidence rates participants aged 30+ years had retention rates ~80% but low incidence rates (2.45 - 3.57 per 100 pyar) while those aged 25–29 years had the highest incidence rates (4.61 - 7.67/100 pyar) and retention rates 78.5 - 83.1%. Conclusions There is high HIV incidence, retention and WTP among fishing communities around L. Victoria, Uganda which make these communities appropriate for future HIV prevention efficacy studies including vaccine trials.
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Affiliation(s)
- Noah Kiwanuka
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda.
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Kenya AIDS Indicator Surveys 2007 and 2012: implications for public health policies for HIV prevention and treatment. J Acquir Immune Defic Syndr 2014; 66 Suppl 1:S130-7. [PMID: 24732817 DOI: 10.1097/qai.0000000000000123] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIDS Indicator Surveys are standardized surveillance tools used by countries with generalized HIV epidemics to provide, in a timely fashion, indicators for effective monitoring of HIV. Such data should guide responses to the HIV epidemic, meet program reporting requirements, and ensure comparability of findings across countries and over time. Kenya has conducted 2 AIDS Indicator Surveys, in 2007 (KAIS 2007) and 2012-2013 (KAIS 2012). These nationally representative surveys have provided essential epidemiologic, sociodemographic, behavioral, and biologic data on HIV and related indicators to evaluate the national HIV response and inform policies for prevention and treatment of the disease. We present a summary of findings from KAIS 2007 and KAIS 2012 and the impact that these data have had on changing HIV policies and practice.
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Prevalence and incidence of HIV infection, trends, and risk factors among persons aged 15-64 years in Kenya: results from a nationally representative study. J Acquir Immune Defic Syndr 2014; 66 Suppl 1:S13-26. [PMID: 24445338 DOI: 10.1097/qai.0000000000000124] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enhanced HIV surveillance using demographic, behavioral, and biologic data from national surveys can provide information to evaluate and respond to HIV epidemics efficiently. METHODS From October 2012 to February 2013, we conducted a 2-stage cluster sampling survey of persons aged 18 months to 64 years in 9 geographic regions in Kenya. Participants answered questionnaires and provided blood for HIV testing. We estimated HIV prevalence, HIV incidence, described trends in HIV prevalence over the past 5 years, and identified factors associated with HIV infection. This analysis was restricted to persons aged 15-64 years. RESULTS HIV prevalence was 5.6% [95% confidence interval (CI): 4.9 to 6.3] in 2012, a significant decrease from 2007, when HIV prevalence, excluding the North Eastern region, was 7.2% (95% CI: 6.6 to 7.9). HIV incidence was 0.5% (95% CI: 0.2 to 0.9) in 2012. Among women, factors associated with undiagnosed HIV infection included being aged 35-39 years, divorced or separated, from urban residences and Nyanza region, self-perceiving a moderate risk of HIV infection, condom use with the last partner in the previous 12 months, and reporting 4 or more lifetime number of partners. Among men, widowhood, condom use with the last partner in the previous 12 months, and lack of circumcision were associated with undiagnosed HIV infection. CONCLUSIONS HIV prevalence has declined in Kenya since 2007. With improved access to treatment, HIV prevalence has become more challenging to interpret without data on new infections and mortality. Correlates of undiagnosed HIV infection provide important information on where to prioritize prevention interventions to reduce transmission of HIV in the broader population.
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Kiwanuka N, Ssetaala A, Nalutaaya A, Mpendo J, Wambuzi M, Nanvubya A, Sigirenda S, Kitandwe PK, Nielsen LE, Balyegisawa A, Kaleebu P, Nalusiba J, Sewankambo NK. High incidence of HIV-1 infection in a general population of fishing communities around Lake Victoria, Uganda. PLoS One 2014; 9:e94932. [PMID: 24866840 PMCID: PMC4035272 DOI: 10.1371/journal.pone.0094932] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background High HIV-1 incidence rates were reported among persons in fisherfolk communities (FFC) in Uganda who were selected for high risk behaviour. We assessed the incidence of HIV-1 and associated risk factors in a general population FFC to determine population-wide HIV rates. Methods A community-based cohort study was conducted among a random sample of 2191 participants aged 18–49 years. At baseline and 12 months post-baseline, data were collected on socio-demographic characteristics and risky behaviors (including number of partners, new partners, condom use, use of alcohol and illicit drug use). Venous blood was collected for HIV serological testing. HIV incidence was calculated per 100 person years at-risk (pyar) and adjusted incidence rate ratios (Adj.IRR) were estimated by multivariable Poisson regression. Results Overall follow up at 12 months was 76.9% (1685/2191) and was significantly higher among HIV uninfected persons and those with at least 1 year duration of stay in community. Overall HIV-1 incidence was 3.39/100 pyar (95% CI: 2.55–4.49). Among the 25–29 years who drank alcohol, HIV incidence was 7.67/100pyar (95% CI;4.62–12.7) while it was 5.67/100pyar (95% CI;3.14–10.2) for 18–24 year olds who drank alcohol. The risk of HIV infection was higher among 25–29 years (adj.IRR = 3.36; 95% CI: 1.48–7.65) and 18–24 years (adj.IRR = 2.65; 95% CI: 1.05–6.70) relative to 30+ years. Compared to non-drinkers, HIV incidence increased by frequency of alcohol drinking - occasional drinkers (adj.IRR = 3.18; 95% CI: 1.18–8.57) and regular drinkers (adj.IRR = 4.93; 95% CI: 1.91–12.8). Conclusion HIV-1 incidence in general fisherfolk population along L.Victoria, Uganda, is high and is mainly associated with young age and alcohol drinking. HIV prevention and control strategies are urgently needed in this population.
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Affiliation(s)
- Noah Kiwanuka
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
- * E-mail:
| | - Ali Ssetaala
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Annet Nalutaaya
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Juliet Mpendo
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Matthias Wambuzi
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Annet Nanvubya
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Simon Sigirenda
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Paul Kato Kitandwe
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | | | - Apolo Balyegisawa
- International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Insitute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Josephine Nalusiba
- Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda
| | - Nelson Kaulukusi Sewankambo
- Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda
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Changing the landscape of the HIV epidemic among MSM in China: results from three consecutive respondent-driven sampling surveys from 2009 to 2011. BIOMED RESEARCH INTERNATIONAL 2014; 2014:563517. [PMID: 24575408 PMCID: PMC3918367 DOI: 10.1155/2014/563517] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022]
Abstract
This study assessed the changes of HIV incidence and its predictors among Beijing's men who have sex with men (MSM). Three consecutive cross-sectional surveys were carried out using a consistent respondent-driven sampling (RDS) approach in 2009, 2010, and 2011, respectively. Structured-questionnaire based interviews were completed with computer-assisted self-administration. Incident infection was examined with BED capture enzyme immunoassay (BED-CEIA). The overall rate of HIV prevalence was 8.0% in the three years (95% confidence interval [CI]: 4.9%-11.2%). The overall rate of BED-CEIA incidence was 7.8/100 person years (PY) (95% CI: 5.5-10.1) with 6.8/100PY (95% CI: 3.4-10.2) in 2009, 11.2/100PY (95% CI: 6.2-16.3) in 2010, and 5.8/100PY (95% CI: 2.4-9.3) in 2011, respectively. Multivariable logistic regression analysis revealed that, compared with HIV-negative MSM, recently infected MSM were more likely to be bisexual (adjusted odds ratio [AOR] = 2.1, 95% CI: 1.1-4.1), live in Beijing ≤3 years (AOR = 2.1, 95% CI: 1.2-4.0), and have a negative attitude towards safe sex (AOR = 1.1 per scale point, 95% CI: 1.0-1.1). This study demonstrated a disturbing rise of HIV infections among Beijing's MSM. These findings underscored the urgency of scaling up effective and better-targeted intervention services to stop the rapid spread of the virus.
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HIV incidence and factors associated with seroconversion in a rural community home based counseling and testing program in Eastern Uganda. AIDS Behav 2014; 18 Suppl 1:S60-8. [PMID: 23695518 DOI: 10.1007/s10461-013-0502-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We estimated HIV incidence and identified risk factors for seroconversion following a rural community home based HIV counseling and testing program in Uganda. We analyzed data from two rounds of testing at least a year apart. Of 19,401 initially seronegative participants, 106 seroconverted in Round 2. Overall HIV incidence was 0.55 per 100 person years (95 % CI: 0.45 -0.66) with no gender difference. Among men, being widowed or divorced (aRR 4.4), and having HIV related symptoms (aRR 11.5) were associated with seroconversion; having primary level education (aRR 0.2) was protective. Among women, being aged 35-59 years (aRR 2.3) and having HIV related symptoms (aRR 9.2) were associated with seroconversion; having couples' posttest counseling in Round 1 (aRR 0.4) was protective. HIV incidence is lower than estimates from elsewhere in Uganda. Nevertheless, focused prevention programs are still needed, targeting previously married men and older women, and including couples' counseling.
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Moyo S, LeCuyer T, Wang R, Gaseitsiwe S, Weng J, Musonda R, Bussmann H, Mine M, Engelbrecht S, Makhema J, Marlink R, Baum MK, Novitsky V, Essex M. Evaluation of the false recent classification rates of multiassay algorithms in estimating HIV type 1 subtype C incidence. AIDS Res Hum Retroviruses 2014; 30:29-36. [PMID: 23937344 DOI: 10.1089/aid.2013.0055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Laboratory cross-sectional assays are useful for the estimation of HIV incidence, but are known to misclassify individuals with long-standing infection as recently infected. The false recent rate (FRR) varies widely across geographic areas; therefore, accurate estimates of HIV incidence require a locally defined FRR. We determined FRR for Botswana, where HIV-1 subtype C infection is predominant, using the BED capture enzyme immunoassay (BED), a Bio-Rad Avidity Index (BAI) assay (a modification of the Bio-Rad HIV1/2+O EIA), and two multiassay algorithms (MAA) that included clinical data. To estimate FRR, stored blood samples from 512 antiretroviral (ARV)-naive HIV-1 subtype C-infected individuals from a prospective cohort in Botswana were tested at 18-24 months postenrollment. The following FRR mean (95% CI) values were obtained: BED 6.05% (4.15-8.48), BAI 5.57% (3.70-8.0), BED-BAI 2.25% (1.13-4.0), and a combination of BED-BAI with CD4 (>200) and viral load (>400) threshold 1.43% (0.58-2.93). The interassay agreement between BED and BAI was 92.8% (95% CI, 90.1-94.5) for recent/long-term classification. Misclassification was associated with viral suppression for BED [adjusted OR (aOR) 10.31; p=0.008], BAI [aOR 9.72; p=0.019], and MAA1 [aOR 16.6; p=0.006]. Employing MAA can reduce FRR to <2%. A local FRR can improve cross-sectional HIV incidence estimates.
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Affiliation(s)
- Sikhulile Moyo
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
| | - Tessa LeCuyer
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Washington State University College of Veterinary Medicine, Pullman, Washington
| | - Rui Wang
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Simani Gaseitsiwe
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Jia Weng
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rosemary Musonda
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Hermann Bussmann
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Madisa Mine
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- National Health Laboratory and Botswana-Harvard HIV Reference Laboratory, Gaborone, Botswana
| | - Susan Engelbrecht
- Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Joseph Makhema
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Richard Marlink
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - Marianna K. Baum
- R. Stempel College of Public Health and Social Work, Florida International University, University Park, Miami, Florida
| | - Vladimir Novitsky
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
| | - M. Essex
- Botswana–Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard School of Public Health AIDS Initiative, Harvard School of Public Health, Boston, Massachusetts
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McKinnon LR, Gakii G, Juno JA, Izulla P, Munyao J, Ireri N, Kariuki CW, Shaw SY, Nagelkerke NJD, Gelmon L, Musyoki H, Muraguri N, Kaul R, Lorway R, Kimani J. High HIV risk in a cohort of male sex workers from Nairobi, Kenya. Sex Transm Infect 2013; 90:237-42. [PMID: 24337729 DOI: 10.1136/sextrans-2013-051310] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) are at high risk of HIV-1 acquisition and transmission, yet there remains limited data in the African context, and for men who sell sex to men (MSM SW) in particular. METHODS We enrolled 507 male sex workers in a Nairobi-based prospective cohort study during 2009-2012. All participants were offered HIV/STI screening, counselling and completed a baseline questionnaire. RESULTS Baseline HIV prevalence was 40.0% (95% CI 35.8% to 44.3%). Prevalent HIV infection was associated with age, less postsecondary education, marijuana use, fewer female partners and lower rates of prior HIV testing. Most participants (73%) reported at least two of insertive anal, receptive anal and insertive vaginal sex in the past 3 months. Vaginal sex was reported by 37% of participants, and exclusive MSM status was associated with higher HIV rates. Condom use was infrequent, with approximately one-third reporting 100% condom use during anal sex. HIV incidence was 10.9 per 100 person-years (95% CI 7.4 to 15.6). Predictors of HIV risk included history of urethral discharge (aHR 0.29, 95% CI 0.08 to 0.98, p=0.046), condom use during receptive anal sex (aHR 0.05, 95% CI 0.01 to 0.41, p=0.006) and frequency of sex with male partners (aHR 1.33/sex act, 95% CI 1.01 to 1.75, p=0.04). CONCLUSIONS HIV prevalence and incidence were extremely high in Nairobi MSM SW; a combination of interventions including increasing condom use, pre-exposure prophylaxis and access to effective treatment is urgently needed to decrease HIV transmission in this key population.
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Affiliation(s)
- Lyle R McKinnon
- Department of Medical Microbiology, University of Nairobi, , Nairobi, Kenya
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Modelling HIV incidence and survival from age-specific seroprevalence after antiretroviral treatment scale-up in rural South Africa. AIDS 2013; 27:2471-9. [PMID: 23842131 PMCID: PMC3815011 DOI: 10.1097/01.aids.0000432475.14992.da] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Our study uses sex-specific and age-specific HIV prevalence data from an ongoing population-based demographic and HIV survey to infer HIV incidence and survival in rural KwaZulu-Natal between 2003 and 2011, a period when antiretroviral treatment (ART) was rolled out on a large scale. DESIGN Catalytic mathematical model for estimating HIV incidence and differential survival in HIV-infected persons on multiple rounds of HIV seroprevalence. METHODS We evaluate trends of HIV incidence and survival by estimating parameters separately for women and men aged 15-49 years during three calendar periods (2003-2005, 2006-2008, 2009-2011) reflecting increasing ART coverage. We compare model-based estimates of HIV incidence with observed cohort-based estimates from the longitudinal HIV surveillance. RESULTS Median survival after HIV infection increased significantly between 2003-2005 and 2009-2011 from 10.0 [95% confidence interval (CI) 8.8-11.2] to 14.2 (95% CI 12.6-15.8) years in women (P < 0.001) and from 10.0 (95% CI 9.2-10.8) to 14.0 (95% CI 10.6-17.4) years in men (P = 0.02). Our model suggests no statistically significant reduction of HIV incidence in the age-group 15-49 years in 2009-2011 compared with 2003-2005. Age-specific and sex-specific model-based HIV incidence estimates were in good agreement with observed cohort-based estimates from the ongoing HIV surveillance. CONCLUSION Our catalytic modelling approach using cross-sectional age-specific HIV prevalence data could be useful to monitor trends of HIV incidence and survival in other African settings with a high ART coverage.
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Mullis CE, Munshaw S, Grabowski MK, Eshleman SH, Serwadda D, Brookmeyer R, Nalugoda F, Kigozi G, Kagaayi J, Tobian AA, Wawer M, Gray RH, Quinn TC, Laeyendecker O. Differential specificity of HIV incidence assays in HIV subtypes A and D-infected individuals from Rakai, Uganda. AIDS Res Hum Retroviruses 2013; 29:1146-50. [PMID: 23641870 DOI: 10.1089/aid.2012.0105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Assays to determine HIV incidence from cross-sectional surveys have exhibited a high rate of false-recent misclassification in Kenya and Uganda where HIV subtypes A and D predominate. Samples from individuals infected with HIV for at least 2 years with known infecting subtype (133 subtype A, 373 subtype D) were tested using the BED-CEIA and an avidity assay. Both assays had a higher rate of false-recent misclassification for subtype D compared to subtype A (13.7% vs. 6.0%, p=0.02 for BED-CEIA; 11.0% vs. 1.5%, p<0.001 for avidity). For subtype D samples, false-recent misclassification by the BED-CEIA was also more frequent in women than men (15.0% vs. 5.6%, p=0.002), and for samples where that had an amino acid other than lysine at position 12 in the BED-CEIA peptide coding region (p=0.002). Furthermore in subtype D-infected individuals, samples misclassified by one assay were 3.5 times more likely to be misclassified by the other assay. Differential misclassification by infecting subtype of long-term infected individuals as recently infected makes it difficult to use these assays individually to estimate population level incidence without precise knowledge of the distribution of these subtypes within populations where subtype A and D cocirculate. The association of misclassification of the BED-CEIA with the avidity assay in subtype D-infected individuals limits the utility of using these assays in combination within this population.
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Affiliation(s)
- Caroline E. Mullis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Supriya Munshaw
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary K. Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susan H. Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Serwadda
- Rakai Health Sciences Program, Rakai, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Ronald Brookmeyer
- Department of Biostatistics, School of Public Health, UCLA, Los Angeles, California
| | | | | | | | - Aaron A.R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Rakai Health Sciences Program, Rakai, Uganda
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Rakai Health Sciences Program, Rakai, Uganda
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Laboratory of Immunoregulation, Division of Intramural Research, NIAID, NIH, Baltimore, Maryland
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Laboratory of Immunoregulation, Division of Intramural Research, NIAID, NIH, Baltimore, Maryland
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Kim AA, Morales S, Lorenzana de Rivera I, Paredes M, Juarez S, Alvarez B, Liu X, Parekh B, Monterroso E, Paz-Bailey G. Short communication: HIV incidence among vulnerable populations in Honduras: results from an integrated behavioral and biological survey among female sex workers, men who have sex with men, and Garifuna in Honduras, 2006. AIDS Res Hum Retroviruses 2013; 29:516-9. [PMID: 23034068 DOI: 10.1089/aid.2012.0032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Honduras has one of the highest HIV prevalence rates in Central America. Data on HIV incidence are needed to identify groups at greatest need of prevention interventions to inform the national HIV response. We applied a test for recent infection to HIV-positive specimens from a biological and behavioral survey to estimate assay-derived incidence among men who have sex with men (MSM), female sex workers (FSW), and the Garifuna population in Honduras. Assay-derived estimates were compared to the mathematically modeled estimates in the same populations to assess plausibility of the assay-based estimates. Assay-derived incidence was 1.1% (95% CI 0.2-2.0) among MSM, 0.4% (95% CI 0.1-0.8) among the Garifuna, and 0% (95% CI 0-0.01) among FSWs. The modeled incidence estimates were similar at 1.03% among MSM, 0.30% among the Garifuna, and 0.23% among FSWs. HIV incidence based on the assay was highest among MSM in Honduras, lowest among FSWs, and similar to modeled incidence in these groups. Targeted programs on HIV prevention, care, and treatment are urgently needed for the MSM population. Continued support for existing prevention programs for FSWs and Garifuna are recommended.
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Affiliation(s)
- Andrea A. Kim
- HHS-Centers for Disease Control and Prevention/Division of Global HIV/AIDS, Atlanta, Georgia
| | - Sonia Morales
- Universidad del Valle de Guatemala, Centro de Estudios en Salud, Guatemala City, Guatemala
| | | | - Mayte Paredes
- Ministry of Health of Honduras, Tegucigalpa, Honduras
| | - Sandra Juarez
- HHS-Centers for Disease Control and Prevention/Division of Global HIV/AIDS/Regional Office for Central America and Panama, Guatemala City, Guatemala
| | - Berta Alvarez
- Universidad del Valle de Guatemala, Centro de Estudios en Salud, Guatemala City, Guatemala
| | - Xin Liu
- HHS-Centers for Disease Control and Prevention/Division of Global HIV/AIDS, Atlanta, Georgia
| | - Bharat Parekh
- HHS-Centers for Disease Control and Prevention/Division of Global HIV/AIDS, Atlanta, Georgia
| | - Edgar Monterroso
- HHS-Centers for Disease Control and Prevention/Division of Global HIV/AIDS, Atlanta, Georgia
| | - Gabriela Paz-Bailey
- Universidad del Valle de Guatemala, Centro de Estudios en Salud, Guatemala City, Guatemala
- Tephinet, Inc. Atlanta, Georgia
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Mahy M, Garcia-Calleja JM, Marsh KA. Trends in HIV prevalence among young people in generalised epidemics: implications for monitoring the HIV epidemic. Sex Transm Infect 2013; 88 Suppl 2:i65-75. [PMID: 23172347 PMCID: PMC3512425 DOI: 10.1136/sextrans-2012-050789] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Countries measure trends in HIV incidence to assess the impact of HIV prevention and treatment programmes. Most countries have approximated trends in HIV incidence through modelled estimates or through trends in HIV prevalence among young people (aged 15–24 years) assuming they have recently become sexually active and have thus only been recently exposed to HIV. Methods Trends in HIV incidence are described and results are compared using three proxy measures of incidence: HIV prevalence among young women attending antenatal clinics (ANCs) in 22 countries; HIV prevalence among young male and female nationally representative household survey respondents in 14 countries; and modelled estimates of adult (ages 15–49 years) HIV incidence in 26 countries. The significance of changes in prevalence among ANC attendees and young survey respondents is tested. Results Among 26 countries, 25 had evidence of some decline in HIV incidence and 15 showed statistically significant declines in either ANC data or survey data. Only in Mozambique did the direction of the trend in young ANC attendees differ from modelled adult incidence, and in Mali and Zambia trends among young men differed from trends in adult incidence. The magnitude of change differed by method. Conclusions Trends in HIV prevalence among young people show encouraging declines. Changes in fertility patterns, HIV-infected children surviving to adulthood, and participation bias could affect future proxy measures of incidence trends.
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Affiliation(s)
- Mary Mahy
- Evidence, Innovation and Policy Department, UNAIDS, Avenue Appia 20, Geneva 1211, Switzerland.
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Laeyendecker O, Brookmeyer R, Mullis CE, Donnell D, Lingappa J, Celum C, Baeten JM, Campbell MS, Essex M, de Bruyn G, Farquhar C, Quinn TC, Eshleman, for the Partners in Preve SH. Specificity of four laboratory approaches for cross-sectional HIV incidence determination: analysis of samples from adults with known nonrecent HIV infection from five African countries. AIDS Res Hum Retroviruses 2012; 28:1177-83. [PMID: 22283149 DOI: 10.1089/aid.2011.0341] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Assays to determine cross-sectional HIV incidence misclassify some individuals with nonrecent HIV infection as recently infected, overestimating HIV incidence. We analyzed factors associated with false-recent misclassification in five African countries. Samples from 2197 adults from Botswana, Kenya, South Africa, Tanzania, and Uganda who were HIV infected > 12 months were tested using the (1) BED capture enzyme immunoassay (BED), (2) avidity assay, (3) BED and avidity assays with higher assay cutoffs (BED+ avidity screen), and (4) multiassay algorithm (MAA) that includes the BED+ avidity screen, CD4 cell count, and HIV viral load. Logistic regression identified factors associated with misclassification. False-recent misclassification rates and 95% confidence intervals were BED alone: 7.6% (6.6, 8.8); avidity assay alone: 3.5% (2.7, 4.3); BED+ avidity screen: 2.2% (1.7, 2.9); and MAA: 1.2% (0.8, 1.8). The misclassification rate for the MAA was significantly lower than the rates for the other three methods (each p < 0.05). Misclassification rates were lower when the analysis was limited to subtype C-endemic countries, with the lowest rate obtained for the MAA [0.8% (0.2, 1.9)]. Factors associated with misclassification were for BED alone: country of origin, antiretroviral treatment (ART), viral load, and CD4 cell count; for avidity assay alone: country of origin; for BED+ avidity screen: country of origin and ART. No factors were associated with misclassification using the MAA. In a multivariate model, these associations remained significant with one exception: the association of ART with misclassification was completely attenuated. A MAA that included CD4 cell count and viral load had lower false-recent misclassification than the BED or avidity assays (alone or in combination). Studies are underway to compare the sensitivity of these methods for detection of recent HIV infection.
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Affiliation(s)
- Oliver Laeyendecker
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron Brookmeyer
- Department of Biostatistics, School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Caroline E. Mullis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah Donnell
- Department of Global Health, University of Washington, Seattle, Washington
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jairam Lingappa
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Mary S. Campbell
- Department of Medicine, University of Washington, Seattle, Washington
| | - Max Essex
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Guy de Bruyn
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Thomas C. Quinn
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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King R, Wamai N, Khana K, Johansson E, Lindkvist P, Bunnell R. "Maybe his blood is still strong": a qualitative study among HIV-sero-discordant couples on ART in rural Uganda. BMC Public Health 2012; 12:801. [PMID: 22984868 PMCID: PMC3599002 DOI: 10.1186/1471-2458-12-801] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 09/13/2012] [Indexed: 01/17/2023] Open
Abstract
Background HIV-negative members of sero-discordant couples are at high risk for HIV acquisition but few behavioral prevention interventions have been implemented in sub-Saharan Africa and discordance is not well understood by couples themselves. Methods In this nested sub-study, we interviewed 40 HIV sero-discordant couples before and after a 6-month behavioral intervention that was comprised of four group discussions on specific HIV prevention and care topics. The content of the sessions included: 1) understanding HIV serodiscordance and reducing risk, 2) couple communication, 3) reproductive health and HIV serodiscordance, 4) coping with HIV serodiscordance and ongoing support. Couple members were interviewed individually. Data were analyzed thematically using ‘Framework Analysis’ which incorporated dyadic factors to address couple issues. Results Analysis revealed pre-identified concepts and emergent themes that were relevant to the final conceptual model. Four major categories of factors affecting couple relations, beliefs and current risk behaviors emerged: intervention factors, structural/contextual factors, physical health factors, and past risk behavior. The topics within the intervention most relevant were communication and reproductive health. The contextual factors highlighted by couples were gender norms around sexual decision-making and multiple partnerships. Individual beliefs regarding HIV serodiscordance persisted over all time points for some couples. Interestingly, some couple members had divergent views about their HIV status; some believing the HIV-negative member was negative while others described multiple beliefs around the negative member’s blood surely being positive for HIV. Couple communication emerged as an important theme mediating beliefs and behavior. Conclusions In addition to biomedical and behavioral interventions, HIV-serodiscordant couple interventions must embrace the contextual complexity and cultural understanding of HIV infection and discordance as well as the dynamic nature of couple communication to influence risk behavior.
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Affiliation(s)
- Rachel King
- Global Health Sciences, University of California, San Francisco, C/O Makerere University School of Public Health, Kampala, Uganda.
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Braunstein SL, van de Wijgert JH, Vyankandondera J, Kestelyn E, Ntirushwa J, Nash D. Risk Factor Detection as a Metric of STARHS Performance for HIV Incidence Surveillance Among Female Sex Workers in Kigali, Rwanda. Open AIDS J 2012; 6:112-21. [PMID: 23056162 PMCID: PMC3465816 DOI: 10.2174/1874613601206010112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/31/2011] [Accepted: 09/13/2011] [Indexed: 11/24/2022] Open
Abstract
Background: The epidemiologic utility of STARHS hinges not only on producing accurate estimates of HIV incidence, but also on identifying risk factors for recent HIV infection. Methods: As part of an HIV seroincidence study, 800 Rwandan female sex workers (FSW) were HIV tested, with those testing positive further tested by BED-CEIA (BED) and AxSYM Avidity Index (Ax-AI) assays. A sample of HIV-negative (N=397) FSW were followed prospectively for HIV seroconversion. We compared estimates of risk factors for: 1) prevalent HIV infection; 2) recently acquired HIV infection (RI) based on three different STARHS classifications (BED alone, Ax-AI alone, BED/Ax-AI combined); and 3) prospectively observed seroconversion. Results: There was mixed agreement in risk factors between methods. HSV-2 coinfection and recent STI treatment were associated with both prevalent HIV infection and all three measures of recent infection. A number of risk factors were associated only with prevalent infection, including widowhood, history of forced sex, regular alcohol consumption, prior imprisonment, and current breastfeeding. Number of sex partners in the last 3 months was associated with recent infection based on BED/Ax-AI combined, but not other STARHS-based recent infection outcomes or prevalent infection. Risk factor estimates for prospectively observed seroconversion differed in magnitude and direction from those for recent infection via STARHS. Conclusions: Differences in risk factor estimates by each method could reflect true differences in risk factors between the prevalent, recently, or newly infected populations, the effect of study interventions (among those followed prospectively), or assay misclassification. Similar investigations in other populations/settings are needed to further establish the epidemiologic utility of STARHS for identifying risk factors, in addition to incidence rate estimation.
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Cherutich P, Kaiser R, Galbraith J, Williamson J, Shiraishi RW, Ngare C, Mermin J, Marum E, Bunnell R. Lack of knowledge of HIV status a major barrier to HIV prevention, care and treatment efforts in Kenya: results from a nationally representative study. PLoS One 2012; 7:e36797. [PMID: 22574226 PMCID: PMC3344943 DOI: 10.1371/journal.pone.0036797] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/06/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We analyzed HIV testing rates, prevalence of undiagnosed HIV, and predictors of testing in the Kenya AIDS Indicator Survey (KAIS) 2007. METHODS KAIS was a nationally representative sero-survey that included demographic and behavioral indicators and testing for HIV, HSV-2, syphilis, and CD4 cell counts in the population aged 15-64 years. We used gender-specific multivariable regression models to identify factors independently associated with HIV testing in sexually active persons. RESULTS Of 19,840 eligible persons, 80% consented to interviews and blood specimen collection. National HIV prevalence was 7.1% (95% CI 6.5-7.7). Among ever sexually active persons, 27.4% (95% CI 25.6-29.2) of men and 44.2% (95% CI 42.5-46.0) of women reported previous HIV testing. Among HIV-infected persons, 83.6% (95% CI 76.2-91.0) were unaware of their HIV infection. Among sexually active women aged 15-49 years, 48.7% (95% CI 46.8-50.6) had their last HIV test during antenatal care (ANC). In multivariable analyses, the adjusted odds ratio (AOR) for ever HIV testing in women ≥35 versus 15-19 years was 0.2 (95% CI: 0.1-0.3; p<0.0001). Other independent associations with ever HIV testing included urban residence (AOR 1.6, 95% CI: 1.2-2.0; p = 0.0005, women only), highest wealth index versus the four lower quintiles combined (AOR 1.8, 95% CI: 1.3-2.5; p = 0.0006, men only), and an increasing testing trend with higher levels of education. Missed opportunities for testing were identified during general or pregnancy-specific contacts with health facilities; 89% of adults said they would participate in home-based HIV testing. CONCLUSIONS The vast majority of HIV-infected persons in Kenya are unaware of their HIV status, posing a major barrier to HIV prevention, care and treatment efforts. New approaches to HIV testing provision and education, including home-based testing, may increase coverage. Targeted interventions should involve sexually active men, sexually active women without access to ANC, and rural and disadvantaged populations.
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Affiliation(s)
- Peter Cherutich
- National AIDS/STI Control Programme (NASCOP), Nairobi, Kenya
| | - Reinhard Kaiser
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- * E-mail:
| | - Jennifer Galbraith
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Williamson
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carol Ngare
- National AIDS/STI Control Programme (NASCOP), Nairobi, Kenya
| | - Jonathan Mermin
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Marum
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Rebecca Bunnell
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Romero-Severson EO, Alam SJ, Volz EM, Koopman JS. Heterogeneity in Number and Type of Sexual Contacts in a Gay Urban Cohort. ACTA ACUST UNITED AC 2012; 4. [PMID: 23638243 DOI: 10.1515/1948-4690.1042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
HIV transmission models include heterogeneous individuals with different sexual behaviors including contact rates, mixing patterns, and sexual practices. However, heterogeneity can also exist within individuals over time. In this paper we analyze a two year prospective cohort of 882 gay men with observations at six month intervals focusing on heterogeneity both within and between individuals in sexual contact rates and sexual roles. The total number of sexual contacts made over the course of the study (mean 1.55 per month) are highly variable between individuals (standard deviation 9.82 per month) as expected. At the individual level, contacts were also heterogeneous over time. For a homogeneous count process the variance should scale with the mean; however, at the individual level the variance scaled with the square root of the mean implying the presence of heterogeneity within individuals over time. We also observed a high level of movement between dichotomous sexual roles (insertive/receptive, protected/unprotected, anal/oral, and HIV status of partners). On average periods of exclusively unprotected sexual contacted lasted 16 months. Our results suggest that future HIV models should consider heterogeneities both between and within individuals in sexual contact rates and sexual roles.
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Abstract
Timothy Hallett and colleagues from the Incidence Assay Critical Path Working Group argue that a quick, easy, valid, and precise method of estimating HIV incidence in populations is needed, and discuss several new technologies to address this need.
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