The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000–2019

Lf, Johnson; Meyer‐Rath, Gesine; Dorrington, Rob; Puren, Adrian; Seathlodi, Thapelo; Zuma, Khangelani; Feizzadeh, Ali

doi:10.1097/qai.0000000000002927

Cited by 20 publications

(19 citation statements)

References 60 publications

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“…The roll-out of antiretroviral treatment since 2004 for the management of HIV infection is a large contributor to the reduction in attributable burden due to unsafe sex. [74] Other reductions in risk-attributable burdens are possibly linked to strengthening the provision of primary healthcare through the development of noncommunicable disease programmes and long-standing maternal and child health programmes. The latter include efforts to improve child and maternal survival through (i) improved nutrition and expansion of the childhood vaccination programme; (ii) healthier pregnancies and safer births; and (iii) social safety nets such as the child and foster care grants.…”

Section: Discussionmentioning

confidence: 99%

Overview

Bradshaw

van-Wyk²,

Neethling³

et al. 2022

S Afr Med J

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Background. South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. Objective. To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. Methods. Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. Results. Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex; alcohol consumption; interpersonal violence; tobacco smoking; and high systolic blood pressure; while for females the leading risks were unsafe sex; interpersonal violence; high systolic blood pressure; high body mass index; and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (–41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). Conclusion. This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.

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Section: Discussionmentioning

confidence: 99%

Overview

Bradshaw

van-Wyk²,

Neethling³

et al. 2022

S Afr Med J

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“…While estimates from the United Nations showed that by 2014 over 2 million or 13% of all adults living with HIV in sub-Saharan Africa were aged 50 years and above (44). Increasing life expectancy, successes of the HIV antiretroviral treatment program, and declining HIV incidence in young adults (44)(45)(46), in addition to risky sexual behavior among older people and the phenomenon of intergenerational sexual relationships (47)(48)(49), are some of the key contributing factors to an increasing number of older adults living with HIV. Thus, KZN as the epicenter of the HIV pandemic and an increasingly aging population was purposively selected as the setting for this study.…”

Section: Study Setting and Populationmentioning

confidence: 99%

“A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs

Nyirenda

Sukazi²,

Buthelezi³

et al. 2023

Front. Public Health

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BackgroundAs the global population ages and the HIV pandemic matures, a growing number of older persons aged ≥50 years are becoming increasingly vulnerable to acquiring HIV. Unfortunately, older persons are often neglected and left out of sexual health programs and services. This study explored the experiences of older persons living with and without HIV in accessing prevention and care services and how those experiences translate into the neglect and abuse of older persons. The study also explored older people's perspectives on community responses to HIV in older people.MethodsThis qualitative analysis used data from 37 individuals who participated in focus group discussions conducted in 2017/2018 across two communities in Durban, South Africa. Using an interview guide and thematic content analysis, salient themes regarding attitudes to HIV in older persons and factors of access to HIV prevention and cares services for older persons were analyzed.ResultsThe study participant's mean age was 59.6 years. Major themes emerging from the data included factors impacting HIV prevention and transmission in older people; community responses to HIV contributing to the abuse of older people, and structural drivers of abuse in older people living with HIV (OPLHIV). Knowledge about HIV and how to protect themselves from HIV was limited among participants. Older persons were frightened to acquire HIV at an older age as they feared judgment and discrimination for getting HIV at that age. OPLHIV reported frequently experiencing community stigma and poor staff attitudes and practices at health facilities, such as a triage health delivery system that fueled community stigma. Participants also experienced neglect, verbal and emotional abuse at healthcare facilities.ConclusionAlthough there were no reports of physical and sexual abuse of older persons in this study, this study shows that despite decades of HIV programs in the country, HIV-related stigma, discrimination, and disrespect of older persons remain pervasive in the community and at health facilities. As an increasing number of people age and live longer with HIV, the neglect and outright abuse of older persons need urgent policy and program interventions.

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“…1 These improvements have resulted, in large part, from the rapid scale-up of life-saving antiretroviral therapy (ART), alongside combination HIV prevention. [2][3][4] Although HIV elimination will only be attained in future generations, measuring progress towards epidemic transition, in which low levels of acquired immunodeficiency syndrome (AIDS) mortality are maintained and new infections are continually reduced, is critical for guiding policy-making at global and local levels. 5,6 The goal of epidemic transition has been encoded into international policy in the UNAIDS Fast Track Strategy, which calls for a 90% reduction in new infections from 2010 levels by 2030.…”

Section: Introductionmentioning

confidence: 99%

Subnational HIV incidence trends in Malawi: large, heterogeneous declines across space

Wolock

Flaxman

Chimpandule

et al. 2023

Preprint

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The rate of new HIV infections globally has decreased substantially from its peak in the late 1990s, but the epidemic persists and remains highest in many countries in eastern and southern Africa. Previous research hypothesised that, as the epidemic recedes, it will become increasingly concentrated among sub-populations and geographic areas where transmission is the highest and that are least effectively reached by treatment and prevention services. However, empirical data on subnational HIV incidence trends is sparse, and the local transmission rates in the context of effective treatment scale-up are unknown. In this work, we developed a novel Bayesian spatio-temporal epidemic model to estimate adult HIV prevalence, incidence and treatment coverage at the district level in Malawi from 2010 through the end of 2021. We found that HIV incidence decreased in every district of Malawi between 2010 and 2021 but the rate of decline varied by area. National-level treatment coverage more than tripled between 2010 and 2021 and more than doubled in every district. Large increases in treatment coverage were associated with declines in HIV transmission, with 12 districts having incidence-prevalence ratios of 0.03 or less (a previously suggested threshold for epidemic control). Across districts, incidence varied more than HIV prevalence and ART coverage, suggesting that the epidemic is becoming increasingly spatially concentrated. Our results highlight the success of the Malawi HIV treatment programme over the past decade, with large improvements in treatment coverage leading to commensurate declines in incidence. More broadly, we demonstrate the utility of spatially resolved HIV modelling in generalized epidemic settings. By estimating temporal changes in key epidemic indicators at a relatively fine spatial resolution, we were able to directly assess, for the first time, whether the ART scaleup in Malawi resulted in spatial gaps or hotspots. Regular use of this type of analysis will allow HIV program managers to monitor the equity of their treatment and prevention programmes and their subnational progress towards epidemic control.

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The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000–2019

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 20 publications

References 60 publications

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“A frightening experience, especially at our age”: Examining the neglect and abuse of older persons in HIV prevention and care programs

Subnational HIV incidence trends in Malawi: large, heterogeneous declines across space

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