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

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dc.contributor.authorFatti, Geoffrey
dc.contributor.authorShaikh, Najma
dc.contributor.authorJackson, Debra
dc.contributor.authorGoga, Ameena
dc.contributor.authorNachega, Jean B.
dc.contributor.authorEley, Brian
dc.contributor.authorGrimwood, Ashraf
dc.date.accessioned2018-10-31T09:01:22Z
dc.date.available2018-10-31T09:01:22Z
dc.date.issued2017
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. Communitybased 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_US
dc.description.accreditationISI
dc.identifier.citationFatti, G. 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.en_US
dc.identifier.issn1932-6203
dc.identifier.urihttps://doi.org/10.1371/journal. pone.0181691
dc.identifier.urihttp://hdl.handle.net/10566/4171
dc.language.isoenen_US
dc.privacy.showsubmitterFALSE
dc.publisherPublic Library of Scienceen_US
dc.rights© 2017 Fatti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
dc.status.ispeerreviewedTRUE
dc.subjectSouthern African womenen_US
dc.subjectHIV incidenceen_US
dc.subjectRisk of HIV acquisitionen_US
dc.subjectHIV prevention interventionsen_US
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_US
dc.typeArticleen_US

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