Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey.

Abstract:

BACKGROUND:In high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities. METHODS:We did a cross-sectional community survey in the adjacent Greater Edendale and Vulindlela areas in the uMgungundlovu district, KwaZulu-Natal, South Africa. Using a multistage cluster sampling method, we randomly selected enumeration areas, households, and individuals. One household member (aged 15-49 years) selected at random was invited for survey participation. After obtaining consent, questionnaires were administered to obtain sociodemographic, psychosocial, and behavioural information, and exposure to HIV prevention and treatment programmes. Clinical samples were collected for laboratory measurements. Statistical analyses were done accounting for multilevel sampling and weighted to represent the population. A multivariable logistic regression model assessed factors associated with HIV infection. FINDINGS:Between June 11, 2014, and June 22, 2015, we enrolled 9812 individuals. The population-weighted HIV prevalence was 36·3% (95% CI 34·8-37·8, 3969 of 9812); 44·1% (42·3-45·9, 2955 of 6265) in women and 28·0% (25·9-30·1, 1014 of 3547) in men (p<0·0001). HIV prevalence in women aged 15-24 years was 22·3% (20·2-24·4, 567 of 2224) compared with 7·6% (6·0-9·3, 124 of 1472; p<0·0001) in men of the same age. Prevalence peaked at 66·4% (61·7-71·2, 517 of 760) in women aged 35-39 years and 59·6% (53·0-66·3, 183 of 320) in men aged 40-44 years. Consistent condom use in the last 12 months was 26·5% (24·1-28·8, 593 of 2356) in men and 22·7% (20·9-24·4, 994 of 4350) in women (p=0·0033); 35·7% (33·4-37·9, 1695 of 5447) of women's male partners and 31·9% (29·5-34·3, 1102 of 3547) of men were medically circumcised (p<0·0001), and 45·6% (42·9-48·2, 1251 of 2955) of women and 36·7% (32·3-41·2, 341 of 1014) of men reported antiretroviral therapy (ART) use (p=0·0003). HIV viral suppression was achieved in 54·8% (52·0-57·5, 1574 of 2955) of women and 41·9% (37·1-46·7, 401 of 1014) of men (p<0·0001), and 87·2% (84·6-89·8, 1086 of 1251) of women and 83·9% (78·5-89·3, 284 of 341; p=0·3670) of men on ART. Age, incomplete secondary schooling, being single, having more than one lifetime sex partner (women), sexually transmitted infections, and not being medically circumcised were associated with HIV-positive status. INTERPRETATION:The HIV burden in specific age groups, the suboptimal differential coverage, and uptake of HIV prevention strategies justifies a location-based approach to surveillance with finer disaggregation by age and sex. Intensified and customised approaches to seek, identify, and link individuals to HIV services are crucial to achieving epidemic control in this community. FUNDING:The President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.

journal_name

Lancet HIV

journal_title

The lancet. HIV

authors

Kharsany ABM,Cawood C,Khanyile D,Lewis L,Grobler A,Puren A,Govender K,George G,Beckett S,Samsunder N,Madurai S,Toledo C,Chipeta Z,Glenshaw M,Hersey S,Abdool Karim Q

doi

10.1016/S2352-3018(18)30104-8

subject

Has Abstract

pub_date

2018-08-01 00:00:00

pages

e427-e437

issue

8

eissn

2405-4704

issn

2352-3018

pii

S2352-3018(18)30104-8

journal_volume

5

pub_type

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    journal_title:The lancet. HIV

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1016/S2352-3018(18)30021-3

    authors: Molina JM,Squires K,Sax PE,Cahn P,Lombaard J,DeJesus E,Lai MT,Xu X,Rodgers A,Lupinacci L,Kumar S,Sklar P,Nguyen BY,Hanna GJ,Hwang C,DRIVE-FORWARD Study Group.

    更新日期:2018-05-01 00:00:00

  • Low-dose ritonavir-boosted darunavir once daily versus ritonavir-boosted lopinavir for participants with less than 50 HIV RNA copies per mL (WRHI 052): a randomised, open-label, phase 3, non-inferiority trial.

    abstract:BACKGROUND:Pilot studies suggest that ritonavir-boosted darunavir could show high efficacy at doses below those currently approved. We investigated whether switch to 400 mg of darunavir boosted with 100 mg ritonavir once daily could show equivalent efficacy to continuation of ritonavir-boosted lopinavir (a protease inh...

    journal_title:The lancet. HIV

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/S2352-3018(19)30081-5

    authors: Venter WDF,Moorhouse M,Sokhela S,Serenata C,Akpomiemie G,Qavi A,Mashabane N,Arulappan N,Sim JW,Sinxadi PZ,Wiesner L,Maharaj E,Wallis C,Boyles T,Ripin D,Stacey S,Chitauri G,Hill A

    更新日期:2019-07-01 00:00:00

  • Effect of expanding opioid agonist therapies on the HIV epidemic and mortality in Ukraine: a modelling study.

    abstract:BACKGROUND:As HIV incidence and mortality continue to increase in eastern Europe and central Asia, particularly among people who inject drugs (PWID), it is crucial to effectively scale-up opioid agonist therapy (OAT), such as methadone or buprenorphine maintenance therapy, to optimise HIV outcomes. With low OAT coverag...

    journal_title:The lancet. HIV

    pub_type: 杂志文章

    doi:10.1016/S2352-3018(19)30373-X

    authors: Tan J,Altice FL,Madden LM,Zelenev A

    更新日期:2020-02-01 00:00:00