Modelling HIV incidence and survival from age-specific seroprevalence after antiretroviral treatment scale-up in rural South Africa

Mossong, Joël; Grapsa, Erofili; Tanser, Frank; Bärnighausen, Till; Newell, Marie‐Louise

doi:10.1097/01.aids.0000432475.14992.da

Cited by 31 publications

(35 citation statements)

References 37 publications

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“…First, in this age-group, younger individuals are on average more likely to be infectious. As our data show for women (see Figure S4), and previous research has shown for both men and women [21], HIV incidence declines with age after 30 even though prevalence continues to rise. Since those with acute incident HIV are far more likely to transmit the disease per sex act [38], higher infection rates for younger partners may reflect this age-distribution of incidence.…”

Section: Discussionsupporting

confidence: 87%

“…This is despite the fact that HIV incidence remains a considerable concern in this age-range: in high-prevalence settings it been measured to be as high as 2% per year for women past their fortieth birthdays [21,22]. Indeed, female HIV incidence at older ages may even be increasing, as older men living with HIV are living and sexually active for longer due to increased ART availability [23], or older individuals remaining in the active sexual network for longer [24].…”

Section: Introductionmentioning

confidence: 99%

“…First, since HIV prevalence declines for men after age 35 [21,31,32], older men are likely to be less, rather than more, infectious than similarly-aged ones for women over 30. Second, since older women are more likely than teenagers to have an income and to have accumulated some wealth, economic gradients are likely to matter less for partner choice in this age group.…”

Section: Introductionmentioning

confidence: 99%

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Partner Age-Disparity and HIV Incidence Risk for Older Women in Rural South Africa

et al. 2015

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While sexual partner age disparity is frequently considered as a potential risk factor for HIV amongst young women in Africa, no research has addressed this question amongst older women. Our aim was thus to determine whether sex partner age disparity was associated with subsequent HIV acquisition in women aged over 30. Methods To achieve this aim we conducted a quantitative analysis of a population-based, open cohort of women in rural KwaZulu-Natal, South Africa (n=1,737) using Cox proportional hazards models. Results As partner age rose, HIV acquisition risk fell significantly: compared to a same-aged partner, a five-year older partner was associated with a one-third reduction (hazard ratio [HR]: 0.63, 95%CI: 0.52–0.76) and a ten-year older partner with a one-half reduction (HR: 0.48, 95%CI: 0.35–0.67). This result was neither confounded nor effect-modified by women’s age or socio-demographic factors. Conclusions These findings suggest that existing HIV risk-reduction campaigns warning young women about partnering with older men may be inappropriate for older women. HIV prevention strategies interventions specifically tailored to older women are needed.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Partner Age-Disparity and HIV Incidence Risk for Older Women in Rural South Africa

et al. 2015

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“…In VIRGO, recommended timeframe guidelines were exceeded in more women than men, particularly for the transfer patients (door-to-balloon >120 min: 67% vs 44%, P<0.001) 11 . Older age is a known independent predictor of achieving goal reperfusion time 13 , which suggests a delay in younger patients —a group that may be more susceptible to sex-differences 22 .…”

Section: Discussionmentioning

confidence: 99%

Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol

Wei

Mehta

Grey

et al. 2017

American Heart Journal

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Aims Recent data from the National Cardiovascular Data Registry indicate that women with ST-segment-elevation myocardial infarction (STEMI) continue to have higher mortality and reported delays in treatment compared to men. We aimed to determine whether the sex difference in mortality exists when treatment disparities are reduced. Methods and Results Using a prospective regional percutaneous-coronary-intervention (PCI)-based STEMI system database with a standardized STEMI protocol, we evaluated baseline characteristics, treatment and clinical outcomes of STEMI patients stratified by sex. From March 2003 to January 2016, 4918 consecutive STEMI patients presented to the Minneapolis Heart Institute at Abbott Northwestern Hospital regional STEMI system including 1416 (28.8%) women. Compared to men, women were older (68.4 vs 60.9 years) with higher rates of hypertension (66.7 vs 55.7%), diabetes (21.7 vs 17.4%) and cardiogenic shock (11.5 vs 8.0%) (all P<0.001). Pre-revascularization medications and PCI were performed with same frequencies, but women were less likely to receive statin or anti-platelet therapy at discharge. After age-adjustment, women had similar in-hospital mortality to men (5.1% vs 4.8%, P=0.60), despite slightly longer door-to-balloon time (95 vs 92 mins, P=0.004). Five-year follow-up confirmed absence of a sex disparity in age-adjusted survival post-STEMI. Conclusions Previously reported treatment disparities between men and women are diminished in a regional PCI-based STEMI system using a standardized STEMI protocol. No sex differences in short-term or long-term age-adjusted mortality are present in this registry despite some treatment disparities. These results suggest that STEMI healthcare disparities and mortality in women can be improved using STEMI protocols and systems.

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“…HIV transmission was represented through heterosexual contact influenced by mixing patterns and behavioral factors including condom use. The model was calibrated using Bayesian methods to longitudinal HIV incidence [13] and prevalence [14] data from KwaZulu-Natal and cross-sectional behavioral riskstratified HIV prevalence data from South Africa [15]. Model details are provided in the Supplementary Data.…”

Section: Model Designmentioning

confidence: 99%

Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa

et al. 2016

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Background. Long-acting injectable antiretrovirals such as rilpivirine (RPV) could promote adherence to preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention. However, the cost-effectiveness of injectable PrEP is unclear.Methods. We constructed a dynamic model of the heterosexual HIV epidemic in KwaZulu-Natal, South Africa, and analyzed scenarios of RPV PrEP scale-up for combination HIV prevention in comparison with a reference scenario without PrEP. We estimated new HIV infections, life-years and costs, and incremental cost-effectiveness ratios (ICERs), over 10-year and lifetime horizons, assuming a societal perspective.Results. Compared with no PrEP, unprioritized scale-up of RVP PrEP covering 2.5%-15% of adults prevented up to 9% of new infections over 10 years. HIV prevention doubled (17%) when the same coverage was prioritized to 20-to 29-year-old women, costing $10 880-$19 213 per infection prevented. Prioritization of PrEP to 80% of individuals at highest behavioral risk achieved comparable prevention (4%-8%) at <1% overall coverage, costing $298-$1242 per infection prevented. Over lifetime, PrEP scale-up among 20-to 29-year-old women was very cost-effective (<$1600 per life-year gained), dominating unprioritized PrEP, while risk prioritization was cost-saving. PrEP's 10-year impact decreased by almost 50% with increases in ICERs (up to 4.2-fold) in conservative base-case analysis. Sensitivity analysis identified PrEP's costs, efficacy, and reliability of delivery as the principal drivers of uncertainty in PrEP's cost-effectiveness, and PrEP remained cost-effective under the assumption of universal access to second-line antiretroviral therapy.Conclusions. Compared with no PrEP, prioritized scale-up of RPV PrEP in KwaZulu-Natal could be very cost-effective or costsaving, but suboptimal PrEP would erode benefits and increase costs.

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Modelling HIV incidence and survival from age-specific seroprevalence after antiretroviral treatment scale-up in rural South Africa

Cited by 31 publications

References 37 publications

Partner Age-Disparity and HIV Incidence Risk for Older Women in Rural South Africa

Partner Age-Disparity and HIV Incidence Risk for Older Women in Rural South Africa

Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol

Cost-effectiveness of Injectable Preexposure Prophylaxis for HIV Prevention in South Africa

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