Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial.
- Department for International Development
- Document Type:
- Journal Article
- Allen, S., de Bruyn, G., Delany-Moretlwe, S., Were, E., Lingappa, J.R. Lambdin, B., Bukusi, E.A., Ngure, K., Kavuma, L., Inambao, M., Kanweka, W., Kiarie, J.N., Makhema, J., Manongi, R., Coetzee, D., Magaret, A., Mugo, N., Mujugira, A., Ndase, P., and Celum, C.
Background: Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regional differences in HIV-1 discordance among African couples, has not previously been reported. Methodology/Principal Findings: The Partners in Prevention HSV-2/HIV-1 Transmission Trial (“Partners HSV-2 Study”), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 2007. Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8–31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r = 0.74, p = 0.09). Conclusions/Significance: HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials.
PLoS ONE (2008) 3 (1): e1411 [doi:10.1371/journal.pone.0001411].
Document Type: Journal Article
Authors: Allen, S. de Bruyn, G. Delany-Moretlwe, S. Were, E. Lingappa, J.R. Lambdin, B. Bukusi, E.A. Ngure, K. Kavuma, L. Inambao, M. Kanweka, W. Kiarie, J.N. Makhema, J. Manongi, R. Coetzee, D. Magaret, A. Mugo, N. Mujugira, A. Ndase, P. Celum, C.