Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa

dc.contributor.authorFatti, Geoffrey
dc.contributor.authorShaikh, Najma
dc.contributor.authorJackson, Debra
dc.contributor.authorGoga, Ameena Ebrahim
dc.contributor.authorNachega, Jean B.
dc.contributor.authorEley, Brian
dc.contributor.authorGrimwood, Ashraf
dc.date.accessioned2017-08-25T08:39:18Z
dc.date.available2017-08-25T08:39:18Z
dc.date.issued2017-07-27
dc.descriptionS1 Fig. Flow chart of women included and excluded from analyses.en_ZA
dc.description.abstractBACKGROUND : Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. METHODS : A cohort study that included HIV-uninfected pregnant women was performed. Lay community-based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox's regression were used to estimate HIV incidence and factors associated with HIV acquisition. RESULTS : The 1356 women included (median age 22.5 years) received 5289 HIV tests. Eleven new HIV infections were detected over 828.3 person-years (PY) of follow-up, with an HIV incidence rate of 1.33 infections/100 PY (95% CI: 0.74±2.40). Antenatally, the HIV incidence rate was 1.49 infections/100 PY (95% CI: 0.64±2.93) and postnatally the HIV incidence rate was 1.03 infections/100 PY (95% CI: 0.33±3.19). 53% of male partners received HIV testing and 66% of eligible partners received referral for circumcision. Women within known serodiscordant couples, and women with newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 (95% CI: 3.8±282.2) and aHR = 126.4 (95% CI: 33.8±472.2) had substantially increased HIV acquisition, respectively. Women with circumcised partners had a reduced risk of incident HIV infection, aHR = 0.22 (95% CI: 0.03±1.86). CONCLUSIONS : Maternal HIV incidence was substantially lower than previous regional studies. Community-based combination HIV prevention interventions may reduce high maternal HIV incidence in resource-poor settings. Expanded roll-out of home-based couples HIV testing and initiating pre-exposure prophylaxis for pregnant women within serodiscordant couples is needed in Southern Africa.en_ZA
dc.description.departmentPaediatrics and Child Healthen_ZA
dc.description.librarianam2017en_ZA
dc.description.sponsorshipThe Positive Action for Children's Fund, ViiV Healthcare, funded the implementation of the program that was evaluated in this study.en_ZA
dc.description.urihttp://www.plosone.orgen_ZA
dc.identifier.citationFatti G, Shaikh N, Jackson D, Goga A, Nachega JB, Eley B, et al. (2017) Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. PLoS ONE 12(7): e0181691. https://DOI.org/ 10.1371/journal.pone.0181691.en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.other10.1371/journal.pone.0181691
dc.identifier.urihttp://hdl.handle.net/2263/61801
dc.language.isoenen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights© 2017 Fatti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License.en_ZA
dc.subjectHIV incidenceen_ZA
dc.subjectHuman immunodeficiency virus (HIV)en_ZA
dc.subjectPregnant womenen_ZA
dc.subjectPostpartum womenen_ZA
dc.subjectPreventionen_ZA
dc.subjectInterventionen_ZA
dc.subjectSouth Africa (SA)en_ZA
dc.titleLow HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africaen_ZA
dc.typeArticleen_ZA

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