Regional Differences in Prevalence of HIV-1 Discordance in Africa and Enrollment of HIV-1 Discordant Couples into an HIV-1 Prevention Trial

Abstract

BackgroundMost HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regional differences in HIV-1 discordance among African couples, has not previously been reported.Methodology/Principal FindingsThe Partners in Prevention HSV-2/HIV-1 Transmission Trial (“Partners HSV-2 Study”), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 2007. Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8–31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r = 0.74, p = 0.09).Conclusions/SignificanceHIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials.

Sexual relations and childbearing decisions of HIV-discordant couples: an exploratory study in South Africa and Tanzania

“…5,12,25,26 The psychosocial 27,28 This exploratory study found that among 36 purposively selected couples in South Africa and Tanzania, HIV and their HIV-discordant status were ever-present issues, influencing their sexual relations and childbearing decisions.…”

“…[9][10][11] A multi-site HIV prevention trial at eastern and southern Africa sites found a prevalence of HIV discordance of 27% in 1,126 couples screened in South Africa and 14% in 477 couples screened in Tanzania. 12 However, with the exception of participants tested for HIV in a research context, many individuals living in resourcepoor countries are unaware of their own and their partners' HIV status. 12 Although discordant couples account for a substantial proportion of new infections, neither programmes nor testing and counselling are geared for such couples.…”

“…12 However, with the exception of participants tested for HIV in a research context, many individuals living in resourcepoor countries are unaware of their own and their partners' HIV status. 12 Although discordant couples account for a substantial proportion of new infections, neither programmes nor testing and counselling are geared for such couples. 1,4 A key challenge for HIV-discordant couples is minimising the risk of HIV transmission to their negative partner(s) and to any children conceived.…”

HIV-1-Specific Enzyme-Linked Immunosorbent Spot Assay Responses in HIV-1-Exposed Uninfected Partners in Discordant Relationships Compared to Those in Low-Risk Controls

“…Non-HIV-1-infected partners in HIV-1-discordant relationships represent one of the largest populations of highly HIV-1-exposed seronegative individuals (HESN) in sub-Saharan Africa, where more than 50% of all couples affected by HIV-1 are discordant (30,50). There are conflicting data on the detection and prevalence of HIV-1-specific CD8 ϩ T cell responses in this population; during the last decade, a number of studies in the United States, Europe, and Africa reported positive HIV-1-specific T cell responses at rates ranging from 10 to 75% among HESN in longterm relationships (2, 4, 5, 9, 14, 19, 22-27, 32, 36, 39, 40, 43-46, 48).…”

Correlates of contraceptive use among HIVdiscordant couples in Kenya

“…In addition 10% of monogamous married couples and 14% of polygamous couples are HIV serodiscordant (KAIS., 2008). Numerous reports have demonstrated that stable HIV discordant couples may be responsible for a majority of HIV infections in Africa (Lingappa et al, 2008;Dunkle et al, 2008).…”