A Comparison of South African National HIV Incidence Estimates: A Critical Appraisal of Different Methods

Rehle, T.; Johnson, Leigh F.; Hallett, Timothy B.; Mahy, Mary; Kim, Andrea; Odido, Helen; Onoya, Dorina; Jooste, Sean; Shisana, Olive; Puren, Adrian; Parekh, Bharat; Stover, John

doi:10.1371/journal.pone.0133255

Cited by 59 publications

(70 citation statements)

References 26 publications

(37 reference statements)

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“…The assay, described elsewhere, has been previously applied in national household surveys in South Africa and Kenya [10–11]. The assay tested for the presence of nevirapine, efavirenz, lamivudine, and lopinavir which were included as one or more drugs in the national standardized first-line or second-line ARV regimens at the time of the survey [12].…”

Section: Methodsmentioning

confidence: 99%

Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012

et al. 2016

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IntroductionUnderstanding the levels and associated factors of non-adherence to antiretroviral therapy (ART) is crucial in designing interventions to improve adherence and health outcomes of ART. We assessed non-adherence to ART among HIV-infected persons reporting ART use in a nationally representative survey in Kenya.MethodsThe Kenya AIDS Indicator Survey 2012 was a population-based, household survey of persons aged 18 months-64 years conducted in 2012–2013. Self-reported information was collected on demographics, sexual behaviour, HIV status, and ART use. Blood was collected for HIV testing, and if HIV infected, CD4 and viral load testing. HIV-positive specimens were tested for the presence of antiretroviral (ARV) drugs using a qualitative ARV assay using liquid chromatography-tandem mass spectrometry. HIV-positive persons who reported receiving ART but did not have the ARV biomarker present were defined as being non-adherent to their ARV medication. We restricted our analysis to HIV-infected persons aged 15–64 years who reported receiving ART and had laboratory-confirmed results from ARV testing. Multivariate logistic regression was used to identify variables associated with non-adherence.ResultsA total of 648 (5.6%; CI 4.9–6.3) tested HIV-positive of whom 559 (86.3%) had sufficient volume of blood to be tested for ARV drugs. Of those, 271 (47.7%; CI 41.8–53.6) self-reported HIV-positive status during the interview and 186 (69.1%; CI 62.2–76.0) of those reported taking ART. The ARV biomarker was absent in 18 of 186 individuals (9.4%; CI 4.9–13.8) who thus were defined as being non-adherent to ART. Non-adherence was associated with being aged 15–29 years (AOR 8.39; CI 2.26–31.22, p = 0.002) compared to aged 30–64 years, rural residence (AOR 5.87; CI 1.39–25.61, p = 0.016) compared with urban residence and taking recreational drugs in the past 30 days (AOR 5.89; CI 1.30–26.70, p = 0.022).ConclusionOverall, less than 10% of Kenyans aged 15–64 years on ART were not adhering to their HIV medication, highlighting the success of the Kenyan national ART program. Our findings, however, point to the need for targeted interventions particularly for young persons, those in rural areas to improve adherence outcomes, as well as delivery of treatment programs that include psychosocial support as a preventative measure to minimize substance abuse and the risk of treatment failure.

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Section: Methodsmentioning

confidence: 99%

Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012

et al. 2016

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“…In 2013, the estimated national seroprevalence of HIV infection in South Africa was 15% in adults aged 15–49 years [3], with an estimated 1000 new infections daily [4]. High prevalence of HIV infection in South Africa places a tremendous burden on the health systems within the country, due largely to opportunistic infections, including invasive nontyphoidal Salmonella (iNTS) infection.…”

Section: Introductionmentioning

confidence: 99%

An association between decreasing incidence of invasive non-typhoidal salmonellosis and increased use of antiretroviral therapy, Gauteng Province, South Africa, 2003–2013

Keddy

Takuva

Musekiwa³

et al. 2017

PLoS ONE

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BackgroundHIV-infected persons are at increased risk of opportunistic infections, including invasive nontyphoidal Salmonella (iNTS) infections; antiretroviral therapy (ART) reduces this risk. We explored changing iNTS incidence associated with increasing ART availability in South Africa.MethodsLaboratory-based surveillance for iNTS was conducted in Gauteng Province, South Africa, with verification using the National Health Laboratory Service’s Central Data Warehouse (CDW), between 2003 and 2013. Isolates were serotyped at the Centre for Enteric Diseases. CDW data on patient numbers obtaining HIV viral load measurements provided estimates of numbers of HIV-infected patients receiving ART. A Poisson regression model was used to measure the changing incidence of iNTS infection from 2003 to 2013. The correlation between the incidence of iNTS and ART use from 2004 to 2013 was determined using Pearson’s correlation coefficient.ResultsFrom 2003–2013, the incidence of iNTS per 100,000 population per year decreased from 5.0 to 2.2 (p < .001). From 2004 to 2013, the incidence per 100,000 population of HIV viral load testing increased from 75.2 to 3,620.3 (p < .001). The most common serotypes causing invasive disease were Salmonella enterica serovar Typhimurium (Salmonella Typhimurium), and Salmonella Enteritidis: 2,469 (55.4%) and 1,156 (25.9%) of 4,459 isolates serotyped, respectively. A strong negative correlation was observed between decreasing iNTS incidence and increasing ART use from 2004 to 2013 (r = -0.94, p < .001). Similarly, decreasing incidence of invasive Salmonella Typhimurium infection correlated with increasing ART use (r = -0.93, p < .001). Incidence of invasive Salmonella Enteritidis infection increased, however (r = 0.95, p < .001). Between 2003 and 2004, fewer adult men than women presented with iNTS (male-to-female rate ratio 0.73 and 0.89, respectively). This was reversed from 2005 through 2013 (ranging from 1.07 in 2005 to 1.44 in 2013). Adult men accessed ART less (male-to-female rate ratio ranging from 0.61 [2004] to 0.67 [2013]).ConclusionsThe incidence of iNTS infections including Salmonella Typhimurium decreased significantly in Gauteng Province in association with increased ART utilization. Adult men accessed ART programs less than women, translating into increasing iNTS incidence in this group. Monitoring iNTS incidence may assist in monitoring the ART program. Increasing incidence of invasive Salmonella Enteritidis infections needs further elucidation.

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“…Young women of child-bearing age have a significantly higher HIV prevalence (5.6% vs. 0.7%) [4–6] and incidence (2.5% vs. 0.6%) [4,7,8] than males of the same age. In addition to increased biological vulnerability of young women, relational risk factors, such as age-disparate relationships, engagement in transactional sex and violence within partnerships [9–11], as well as individual risk behaviours – such as inconsistent condom use, number of partners and age at sexual debut – have been found to be associated with young women's risk of HIV infection [12].…”

Section: Introductionmentioning

confidence: 99%

Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection

Ranganathan

Heise

Pettifor

et al. 2016

Journal of the International AIDS Society

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IntroductionYoung adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours.MethodsWe analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13–20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI.ResultsOverall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19–5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship.ConclusionsThis study provides quantitative support demonstrating that transactional sex is associated with HIV infection in young women. Even though the specific variables tested do not mediate the relationship, a potential explanation for this association may be that the men with whom young women are having sex belong to networks of sexually connected individuals who are at a “high risk” for HIV infection. The results highlight the importance of structural intervention approaches that can alter the context of young women's HIV risk.

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A Comparison of South African National HIV Incidence Estimates: A Critical Appraisal of Different Methods

Cited by 59 publications

References 26 publications

Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012

Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012

An association between decreasing incidence of invasive non-typhoidal salmonellosis and increased use of antiretroviral therapy, Gauteng Province, South Africa, 2003–2013

Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection

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