Cargando…

Combination HIV Prevention and HIV Incidence in Uganda

BACKGROUND: To assess the impact of combination HIV prevention (CHP) on HIV incidence, we analyzed the association between HIV incidence and scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral load suppression and sexual behavior...

Descripción completa

Detalles Bibliográficos
Autores principales: Grabowski, Mary K, Serwadda, David M, Gray, Ronald H, Nakigozi, Gertrude, Kigozi, Godfrey, Kagaayi, Joseph, Ssekubugu, Robert, Nalugoda, Fred, Lessler, Justin, Lutalo, Thomas, Galiwango, Ronald, Makumbi, Fred, Kong, Xiangrong, Kabatesi, Donna, Alamo, Stella T, Wiersma, Steven, Sewankambo, Nelson K, Tobian, Aaron A R, Laeyendecker, Oliver, Quinn, Thomas C, Reynolds, Steven J, Wawer, Maria J, Chang, Larry W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Massachusetts Medical Society 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627523/
https://www.ncbi.nlm.nih.gov/pubmed/29171817
http://dx.doi.org/10.1056/NEJMoa1702150
Descripción
Sumario:BACKGROUND: To assess the impact of combination HIV prevention (CHP) on HIV incidence, we analyzed the association between HIV incidence and scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral load suppression and sexual behaviors were also examined. METHODS: Between 1999 and 2016, data were collected through 12 surveys from 30 communities in the Rakai Community Cohort Study, an open population-based cohort of persons aged 15-49 years. We assessed HIV incidence trends based on observed seroconversion data, self-reported ART and male circumcision coverage, viral load suppression, and sexual behaviors. RESULTS: In total, 33,937 study participants contributed 103,011 person-visits (HIV prevalence ~13%). Follow-up of 17,870 HIV-negative persons contributed 94,427 person-years with 931 seroconversions. ART was introduced in 2004; by 2016 coverage was 69% (72% in women vs. 61% in men, p<0.001). HIV viral load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (p<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (p<0.001). Persons 15-19 years reporting n 71 ever having sex increased from 30% to 55% (p<0.0001). HIV incidence declined by 42% in 2016 relative to the pre-CHP period prior to 2010 (1.17/100 py to 0.66/100 py; adjIRR:0.58: 95%CI: 0.45-0.76); declines were greater in men (adjIRR=0.46; 95%CI: 0.29-0.73) than women (adjIRR=0.68, 95%CI: 0.50-0.94). CONCLUSIONS: In this longitudinal study, HIV incidence significantly declined with CHP scale-up, providing empiric evidence that HIV control interventions can have substantial population-level impact. However, additional efforts are needed to overcome gender disparities and achieve HIV elimination.