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Is There Risk Compensation among HIV Infected Youth and Adults 15 Years and Older on Antiretroviral Treatment in South Africa? Findings from the 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106156. [PMID: 35627693 PMCID: PMC9141949 DOI: 10.3390/ijerph19106156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
In this paper, risk compensation among individuals on antiretroviral therapy (ART), using the 2017 South African national survey on HIV, is explored. A multi-stage stratified cluster random sampling approach was used to realize 11,130 participants 15 years and older. Logistic regression analysis assessed the association between multiple sexual partners, condom use at last sexual encounter, consistency of condom usage and potential explanatory variables using HIV status and ART exposure as a mediator variable. HIV positive participants who were aware and on ART were less likely to have multiple sexual partners, and less likely not to use a condom at last sex compared to HIV positive participants who were aware but not on ART. The odds of reporting multiple sexual partners were significantly lower among older age groups, females, non-Black Africans, and rural settings, and higher among those with tertiary level education, and risky alcohol users. The odds of no condom use at last sexual encounter were more likely among older age groups, females, other race groups, and less likely among those with secondary level education. The odds of inconsistent condom use were more likely among older age groups, females, and other race groups, and less likely among those with tertiary level education, high risk and hazardous alcohol users. Risk compensation is not apparent among HIV infected adults who are on ART. Risk groups that should receive tailored interventions to reduced risky sexual behaviours were identified.
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Khosropour CM, Dombrowski JC, Barbee LA, Kerani RP, Berzkalns A, Golden MR. Changing Patterns of Sexual Behavior and HIV/STI Among Men Who Have Sex With Men in Seattle, 2002 to 2018. J Acquir Immune Defic Syndr 2021; 87:1032-1039. [PMID: 33770066 PMCID: PMC8458506 DOI: 10.1097/qai.0000000000002686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The extent to which uptake of biomedical HIV prevention strategies have affected population-level sexual behavior and sexually transmitted infections (STIs) among men who have sex with men (MSM) is not well understood. METHODS We collected data as part of routine care from MSM attending the municipal STI clinic in Seattle, Washington, 2002-2018. MSM were asked about condom use in the previous 12 months. We classified behaviors into 4 mutually exclusive categories: no anal sex; consistent condom use for anal sex; serosorting [condomless anal sex (CAS) only with HIV-concordant partners]; and CAS with serodiscordant/unknown-status partners. STI/HIV testing was performed per routine clinic protocol. RESULTS There were 45,656 and 6987 visits by MSM without HIV and MSM with HIV, respectively. The use of antiretroviral therapy and preexposure prophylaxis increased substantially during the study period to 94% and 50%, respectively, by 2018. CAS with serodiscordant/unknown-status partners decreased through 2013 but increased thereafter (to 40% among MSM without HIV; 68% among MSM with HIV). Serosorting increased among MSM without HIV but declined after 2013 among MSM with HIV. Consistent condom use declined for all MSM (from 35% to 11% among MSM without HIV; from 20% to 5% among MSM with HIV). HIV test positivity declined substantially (3.5%-0.5%), whereas STI test positivity increased over time. CONCLUSIONS Since 2013, CAS with HIV-discordant/unknown-status partners increased substantially concurrent with declining HIV test positivity and increasing STI test positivity. This highlights the success of biomedical HIV prevention strategies to reduce HIV incidence while affirming the need for new approaches to STI prevention.
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Affiliation(s)
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Lindley A. Barbee
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Anna Berzkalns
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
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Janulis P, Goodreau SM, Birkett M, Phillips G, Morris M, Mustanski B, Jenness SM. Temporal Variation in One-Time Partnership Rates Among Young Men Who Have Sex With Men and Transgender Women. J Acquir Immune Defic Syndr 2021; 87:e214-e221. [PMID: 33675616 PMCID: PMC8192435 DOI: 10.1097/qai.0000000000002679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Volatility in sexual contact rates has been recognized as an important factor influencing HIV transmission dynamics. One-time partnerships may be particularly important given the potential to quickly accumulate large number of contacts. Yet, empirical data documenting individual variation in contact rates remain rare. This study provides much needed data on temporal variation in one-time partners to better understand behavioral dynamics and improve the accuracy of transmission models. METHODS Data for this study were obtained from a longitudinal cohort study of young men who have sex with men and transgender women in Chicago. Participants provided sexual network data every 6 months for 2 years. A series of random effects models examined variation in one-time partnership rates and disaggregated within and between associations of exposure variables. Exposure variables included prior number of one-time partners, number of casual partners, and having a main partner. RESULTS Results indicated substantial between-person and within-person variation in one-time partners. Casual partnerships were positively associated and main partnerships negatively associated with one-time partnership rates. There remained a small positive association between prior one-time partnerships and the current number of one-time partnerships. CONCLUSIONS Despite the preponderance of a low number of one-time partners, substantial variation in one-time partnership rates exists among young men who have sex with men and transgender women. Accordingly, focusing on high contact rate individuals alone may be insufficient to identify periods of highest risk. Future studies should use these estimates to more accurately model how volatility impacts HIV transmission and better understand how this variation influences intervention effectiveness.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Steven M Goodreau
- Departments of Anthropology and Epidemiology, University of Washington
| | - Michelle Birkett
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
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Wang L, Moqueet N, Lambert G, Grace D, Rodrigues R, Cox J, Lachowsky NJ, Noor SW, Armstrong HL, Tan DHS, Burchell AN, Ma H, Apelian H, Knight J, Messier-Peet M, Jollimore J, Baral S, Hart TA, Moore DM, Mishra S. Population-Level Sexual Mixing According to HIV Status and Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Montreal, Canada: Implications for HIV Prevention. Am J Epidemiol 2020; 189:44-54. [PMID: 31612213 PMCID: PMC7119299 DOI: 10.1093/aje/kwz231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022] Open
Abstract
Using cross-sectional survey data (Engage, 2017–2018) from 1,137 men who have sex with men, ≥16 years old, in Montreal, we compared observed human immunodeficiency virus (HIV) seroconcordance in previous-6-months’ sexual partnerships with what would have been observed by chance if zero individuals serosorted. Of 5 recent partnerships where both individuals were HIV-negative, we compared observed concordance in preexposure prophylaxis (PrEP) use with the counterfactual if zero individuals selected partners based on PrEP use. We estimated the concordance by chance using a balancing-partnerships approach assuming proportionate mixing. HIV-positive respondents had a higher proportion of HIV-positive partners (66.4%, 95% confidence interval (CI): 64.0, 68.6) than by chance (23.9%, 95% CI: 23.1, 24.7). HIV-negative respondents (both on and not on PrEP) had higher proportions of HIV-negative partners (82.9% (95% CI: 81.1, 84.7) and 90.7% (95% CI: 89.6, 91.7), respectively) compared with by chance (76.1%, 95% CI: 75.3, 76.9); however, those on PrEP had a higher proportion of HIV-positive partners than those not on PrEP (17.1% (95% CI: 15.3, 18.9) vs. 9.3% (95% CI: 8.3, 10.4). Those on PrEP also had a higher proportion of partners on PrEP among their HIV-negative partners (50.6%, 95% CI: 42.5, 58.8) than by chance (28.5%, 95% CI: 27.5, 29.4). The relationship between PrEP and sexual-mixing patterns demonstrated by less population-level serosorting among those on PrEP and PrEP-matching warrants consideration during PrEP roll-out.
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Affiliation(s)
- Linwei Wang
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Nasheed Moqueet
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ricky Rodrigues
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Darrell H S Tan
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Huiting Ma
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Herak Apelian
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jesse Knight
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Marc Messier-Peet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Department of Medicine, Division of AIDS, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sharmistha Mishra
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
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Kim H, Harling G, Vandormael A, Tomita A, Cuadros DF, Bärnighausen T, Tanser F. HIV seroconcordance among heterosexual couples in rural KwaZulu-Natal, South Africa: a population-based analysis. J Int AIDS Soc 2020; 23:e25432. [PMID: 31916420 PMCID: PMC6949466 DOI: 10.1002/jia2.25432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION High levels of HIV seroconcordance at the population level reduce the potential for effective HIV transmission. However, the level of HIV seroconcordance is largely unknown among heterosexual couples in sub-Saharan Africa. We aimed to quantify the population level HIV seroconcordance in stable heterosexual couples in rural South Africa. METHODS We followed adults (≥15 years old) using a population-based, longitudinal and open surveillance system in KwaZulu-Natal, South Africa, from 2003 to 2016. Sexual partnerships and HIV status were confirmed via household surveys and annual HIV surveillance. We calculated the proportions of HIV seroconcordance and serodiscordance in stable sexual partnerships and compared them to the expected proportions under the assumption of random mixing using individual-based microsimulation models. Among unpartnered individuals, we estimated the incidence rates and hazard of sexual partnership formation with HIV-positive or HIV-negative partners by participants' own time-varying HIV status. Competing risks survival regressions were fitted adjusting for sociodemographic and clinical factors. We also calculated Newman's assortativity coefficients. RESULTS A total of 18,341 HIV-negative and 11,361 HIV-positive individuals contributed 154,469 person-years (PY) of follow-up. Overall, 28% of the participants were in stable sexual partnerships. Of the 677 newly formed stable sexual partnerships, 7.7% (95% CI: 5.8 to 10.0) were HIV-positive seroconcordant (i.e. both individuals in the partnership were HIV-positive), which was three times higher than the expected proportion (2.3%) in microsimulation models based on random mixing. The incidence rates of sexual partnership formation were 0.54/1000PY with HIV-positive, 1.12/1000PY with HIV-negative and 2.65/1000PY with unknown serostatus partners. HIV-positive individuals had 2.39 (95% CI: 1.43 to 3.99) times higher hazard of forming a sexual partnership with an HIV-positive partner than did HIV-negative individuals after adjusting for age, opposite-sex HIV prevalence (by 5-years age groups), HIV prevalence in the surrounding community, ART coverage and other sociodemographic factors. Similarly, forming a sexual partnership with an HIV-negative partner was 1.47 (95% CI: 1.01 to 2.14) times higher in HIV-negative individuals in the adjusted model. Newman's coefficient also showed that assortativity by participant and partner HIV status was moderate (r = 0.35). CONCLUSIONS A high degree of population level HIV seroconcordance (both positive and negative) was observed at the time of forming new sexual partnerships. Understanding factors driving these patterns may help the development of strategies to bring the HIV epidemic under control.
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Affiliation(s)
- Hae‐Young Kim
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNYUSA
| | - Guy Harling
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Institute for Global HealthUniversity College LondonLondonUK
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
| | - Alain Vandormael
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
| | - Andrew Tomita
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP)KwaZulu‐NatalSouth Africa
- Centre for Rural HealthSchool of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Diego F Cuadros
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Geography and Geographic Information ScienceUniversity of CincinnatiCincinnatiOHUSA
| | - Till Bärnighausen
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Heidelberg Institute of Global HealthFaculty of MedicineUniversity of HeidelbergHeidelbergGermany
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Frank Tanser
- Africa Health Research InstituteKwaZulu‐NatalSouth Africa
- Department of Epidemiology & Harvard Center for Population and Development StudiesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Lincoln Institute for HealthUniversity of LincolnLincolnUK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)University of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
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Harling G, Tsai AC. Using Social Networks to Understand and Overcome Implementation Barriers in the Global HIV Response. J Acquir Immune Defic Syndr 2019; 82 Suppl 3:S244-S252. [PMID: 31764260 PMCID: PMC6923140 DOI: 10.1097/qai.0000000000002203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the development of several efficacious HIV prevention and treatment methods in the past 2 decades, HIV continues to spread globally. Uptake of interventions is nonrandomly distributed across populations. Such inequality is socially patterned and reinforced by homophily arising from both social selection (becoming friends with similar people) and influence (becoming similar to friends). METHODS We conducted a narrative review to describe how social network analysis methods-including egocentric, sociocentric, and respondent-driven sampling designs-provide tools to measure key populations, to understand how epidemics spread, and to evaluate intervention take-up. RESULTS Social network analysis-informed designs can improve intervention effectiveness by reaching otherwise inaccessible populations. They can also improve intervention efficiency by maximizing spillovers, through social ties, to at-risk but susceptible individuals. Social network analysis-informed designs thus have the potential to be both more effective and less unequal in their effects, compared with social network analysis-naïve approaches. Although social network analysis-informed designs are often resource-intensive, we believe they provide unique insights that can help reach those most in need of HIV prevention and treatment interventions. CONCLUSION Increased collection of social network data during both research and implementation work would provide important information to improve the roll-out of existing studies in the present and to inform the design of more data-efficient, social network analysis-informed interventions in the future. Doing so will improve the reach of interventions, especially to key populations, and to maximize intervention impact once delivered.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard University, Cambridge MA, United States
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C. Tsai
- Department of Epidemiology and Harvard Center for Population and Development Studies, Harvard University, Cambridge MA, United States
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston MA United States
- Mbarara University of Science and Technology, Mbarara, Uganda
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Abstract
CONTEXT Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms. METHODS As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time. RESULTS CLS with regular partner varied between 29-51% and 23-46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5-12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24-5.45)]. CONCLUSION Universal Test and Treat was not associated with increased sexual risk behaviours.
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Tanser F, Vandormael A, Cuadros D, Phillips AN, de Oliveira T, Tomita A, Bärnighausen T, Pillay D. Effect of population viral load on prospective HIV incidence in a hyperendemic rural African community. Sci Transl Med 2018; 9:9/420/eaam8012. [PMID: 29237762 DOI: 10.1126/scitranslmed.aam8012] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/14/2017] [Accepted: 08/21/2017] [Indexed: 01/11/2023]
Abstract
Monitoring HIV population viral load (PVL) has been advocated as an important means of inferring HIV transmission potential and predicting the future rate of new HIV infections (HIV incidence) in a particular community. However, the relationship between PVL measures and directly measured HIV incidence has not been quantified in any setting and, most importantly, in a hyperendemic sub-Saharan African setting. We assessed this relationship using one of Africa's largest population-based prospective population cohorts in rural KwaZulu-Natal, South Africa in which we followed 8732 HIV-uninfected participants between 2011 and 2015. Despite clear evidence of spatial clustering of high viral loads in some communities, our results demonstrate that PVL metrics derived from aggregation of viral load data only from the HIV-positive members of a particular community did not predict HIV incidence in this typical hyperendemic, rural African population. Only once we used modified PVL measures, which combined viral load information with the underlying spatial variation in the proportion of the population infected (HIV prevalence), did we find a consistently strong relationship with future risk of HIV acquisition. For example, every 1% increase in the overall proportion of a population having detectable virus (PDV P ) was independently associated with a 6.3% increase in an individual's risk of HIV acquisition (P = 0.001). In hyperendemic African populations, these modified PVL indices could play a key role in targeting and monitoring interventions in the most vulnerable communities where the future rate of new HIV infections is likely to be highest.
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Affiliation(s)
- Frank Tanser
- Africa Health Research Institute, Durban 4001, South Africa. .,School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban 4001, South Africa.,Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK
| | - Alain Vandormael
- Africa Health Research Institute, Durban 4001, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Diego Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH 45220, USA
| | - Andrew N Phillips
- Institute for Global Health, University College London, London WC1E 6JB, UK
| | - Tulio de Oliveira
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban 4001, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Andrew Tomita
- Africa Health Research Institute, Durban 4001, South Africa.,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, Durban 4001, South Africa.,Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02138, USA.,Heidelberg Institute for Public Health, University of Heidelberg, Heidelberg 69117, Germany
| | - Deenan Pillay
- Africa Health Research Institute, Durban 4001, South Africa.,Division of Infection and Immunity, University College London, London WC1E 6JB, UK
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Belief in Treatment as Prevention and Its Relationship to HIV Status and Behavioral Risk. J Acquir Immune Defic Syndr 2017; 77:8-16. [PMID: 28991882 DOI: 10.1097/qai.0000000000001557] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated attitudes toward treatment as prevention (TasP) among gay, bisexual, and other men who have sex with men (GBM) in Vancouver, Canada. METHODS Sexually active GBM, aged ≥16 years, were recruited between 2012 and 2015 using respondent-driven sampling. At each 6-month follow-up, participants completed a computer-administered questionnaire and nursing visit. Repeated-measures latent class analysis, grouped by self-reported serostatus, identified patterns of TasP endorsement by considering TasP-related awareness, attitudes, and behavior. Binary logistic regression identified covariates of class membership. Bivariate interactions with visit number identified factors associated with longitudinal changes in class membership. RESULTS A total of 774 men provided 2590 observations. Of these, 698 enrolled in the cohort, 575 had at least 1 follow-up visit. Among these, the median follow-up time was 1.98 years (Q1-Q2: 1.49-2.49 years). Repeated-measures latent class analysis identified 3 classes: "unaware" (64.2% HIV negative/unknown vs. 29.2% of HIV positive), "skeptical" (29.7% vs. 23.1%), and "believing" (6.1% vs. 47.7%). Membership in classes representing higher TasP endorsement was associated with greater odds of condomless anal sex and having more sexual partners. Age, sexual orientation, ethnicity, substance use, and social time spent with other GBM were also associated with class membership. Longitudinally, class membership was stable among HIV-positive men but shifted toward greater TasP endorsement among HIV-negative/unknown men. For HIV-negative/unknown men, increasing endorsement was positively associated with greater education, being employed, being in a relationship, and substance use and inversely associated with recent serodiscordant condomless anal sex or sexually transmitted infection diagnosis. CONCLUSIONS Over time, disparities in TasP diffusion by HIV status have lessened, although continue to persist across other key social strata.
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