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, Geoffreyen_ZA
dc.contributor.authorShaikh, Najmaen_ZA
dc.contributor.authorJackson, Debraen_ZA
dc.contributor.authorGoga, Ameenaen_ZA
dc.contributor.authorNachega, Jean B.en_ZA
dc.contributor.authorEley, Brianen_ZA
dc.contributor.authorGrimwood, Ashrafen_ZA
dc.date.accessioned2019-02-25T14:18:07Z
dc.date.available2019-02-25T14:18:07Z
dc.date.issued2017
dc.descriptionCITATION: Fatti, G., et al. 2017. Low HIV incidence in pregnant and postpartum women receiving a communitybased combination HIV prevention intervention in a high HIV incidence setting in South Africa. PLoS ONE, 12(7):e0181691, doi:10.1371/journal.pone.0181691.
dc.descriptionThe original publication is available at https://journals.plos.org/plosone
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.urihttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181691
dc.description.versionPublisher's version
dc.format.extent15 pages
dc.identifier.citationFatti, G., et al. 2017. Low HIV incidence in pregnant and postpartum women receiving a communitybased combination HIV prevention intervention in a high HIV incidence setting in South Africa. PLoS ONE, 12(7):e0181691, doi:10.1371/journal.pone.0181691
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0181691
dc.identifier.urihttp://hdl.handle.net/10019.1/105471
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectMaternal HIV incidenceen_ZA
dc.subjectHIV infections -- Preventionen_ZA
dc.subjectPregnant women -- Health and hygieneen_ZA
dc.subjectCommunity based health careen_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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