A decade of sustained geographic spread of HIV infections among women in Durban, South Africa

Abstract

Background Fine scale geospatial analysis of HIV infection patterns can be used to facilitate geographically targeted interventions. Our objective was to use the geospatial technology to map age and time standardized HIV incidence rates over a period of 10 years to identify communities at high risk of HIV in the greater Durban area. Methods HIV incidence rates from 7557 South African women enrolled in five community-based HIV prevention trials (2002–2012) were mapped using participant household global positioning system (GPS) coordinates. Age and period standardized HIV incidence rates were calculated for 43 recruitment clusters across greater Durban. Bayesian conditional autoregressive areal spatial regression (CAR) was used to identify significant patterns and clustering of new HIV infections in recruitment communities. Results The total person-time in the cohort was 9093.93 years and 613 seroconversions were observed. The overall crude HIV incidence rate across all communities was 6·74 per 100PY (95% CI: 6·22–7·30). 95% of the clusters had HIV incidence rates greater than 3 per 100PY. The CAR analysis identified six communities with significantly high HIV incidence. Estimated relative risks for these clusters ranged from 1.34 to 1.70. Consistent with these results, age standardized HIV incidence rates were also highest in these clusters and estimated to be 10 or more per 100 PY. Compared to women 35+ years old younger women were more likely to reside in the highest incidence areas (aOR: 1·51, 95% CI: 1·06–2·15; aOR: 1.59, 95% CI: 1·19–2·14 and aOR: 1·62, 95% CI: 1·2–2·18 for < 20, 20–24, 25–29 years old respectively). Partnership factors (2+ sex partners and being unmarried/not cohabiting) were also more common in the highest incidence clusters (aOR 1.48, 95% CI: 1.25–1.75 and aOR 1.54, 95% CI: 1.28–1.84 respectively). Conclusion Fine geospatial analysis showed a continuous, unrelenting, hyper HIV epidemic in most of the greater Durban region with six communities characterised by particularly high levels of HIV incidence. The results motivate for comprehensive community-based HIV prevention approaches including expanded access to PrEP. In addition, a higher concentration of HIV related services is required in the highest risk communities to effectively reach the most vulnerable populations. Electronic supplementary material The online version of this article (10.1186/s12879-019-4080-6) contains supplementary material, which is available to authorized users.

Geo-Analysis: The Distribution of Community Health Workers in Relation to the HIV Prevalence in Kwazulu-Natal Province, South Africa

“…There was no clear pattern of the distribution of CHWs in relation to the HIV prevalence. This is in line with the evidence which showed that there is disparity in the distribution of CHWs in KZN [6,8] and as well as wide variation of HIV prevalence in KZN districts [27,37] . Furthermore, the study showed that districts with a high HIV prevalence have the lowest number of CHWs allocated to them and vise-versa, although this was not observed across all districts.…”

“…This can be achieved by the use of geospatial analysis. In HIV related research, geospatial analysis has been successfully used, for example, to locate areas of male medical circumcision [26] , determine areas of high HIV prevalence [27] , and determine spatial relationships between HIV prevalence and social covariates [28] . Therefore, using geospatial analysis, our study aims to map and describe the distribution of CHWs in relation to the HIV prevalence in the districts where they are deployed.…”

“My partner was not fond of using condoms and I was not on contraception”: understanding adolescent mothers’ perspectives of sexual risk behaviour in KwaZulu-Natal, South Africa

“…Prior studies have noted the impact of peer pressure that prompts adolescents to engage in risky sexual behaviour [1,19,20,46,52]. Some of the adolescent mothers in this study stated that engaging in sex had become the norm and was a 'fashion trend'.…”

“…The high burden of HIV in KwaZulu Natal disproportionately affects women and adolescent girls because the economic, social, cultural and behavioural factors [45]. Ugu district is largely rural with an HIV antenatal prevalence of 41% [46]. Twenty-three percent of the deliveries at this district hospital involves adolescent girls between 13 and 19 years of age [47].…”

Early access to antiretroviral therapy versus standard of care among HIV‐positive participants in Eswatini in the public health sector: the MaxART stepped‐wedge randomized controlled trial

“…However, when we assume that those who died, were lost to follow‐up or were likely untreated due to not having VLs measured were all unsuppressed, as in the definition given in Figure , the six‐ and twelve‐month suppression rates were 0.90 and 0.79 in the EAAA participants, and 0.22 and 0.04 among SoC participants. Most studies are likely estimating suppression rates with these anti‐conservative assumptions, while the estimates we provided in our primary analysis may be much closer to the reality and could explain, at least in part, why transmission is still so high in, for example, Kwa Zulu Natal, South Africa, bordering Eswatini [30]. Calendar time was controlled for in all analyses, thus eliminating background time trends related to a general improvement in the quality of care as an explanation for the large observed increase in viral suppression among the EAAA group.…”