Jessica Justman1, Jason B Reed2, George Bicego3, Deborah Donnell4, Keala Li4, Naomi Bock3, Alison Koler5, Neena M Philip6, Charmaine K Mlambo7, Bharat S Parekh3, Yen T Duong6, Dennis L Ellenberger3, Wafaa M El-Sadr6, Rejoice Nkambule8. 1. ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA. Electronic address: jj2158@columbia.edu. 2. Jhpiego, Washington, DC, USA. 3. US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, GA, USA. 4. Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 5. Pact, Dar es Salaam, Tanzania. 6. ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA. 7. Clinton Health Access Initiative, Mbabane, Swaziland. 8. Ministry of Health-Swaziland, Mbabane, Swaziland.
Abstract
BACKGROUND: Swaziland has the highest national HIV prevalence worldwide. The Swaziland HIV Incidence Measurement Survey (SHIMS) provides the first national HIV incidence estimate based on prospectively observed HIV seroconversions. METHODS: A two-stage survey sampling design was used to select a nationally representative sample of men and women aged 18-49 years from 14 891 households in 575 enumeration areas in Swaziland, who underwent household-based counselling and rapid HIV testing during 2011. All individuals aged 18-49 years who resided or had slept in the household the night before and were willing to undergo home-based HIV testing, answer demographic and behavioural questions in English or siSwati, and provide written informed consent were eligible for the study. We performed rapid HIV testing and assessed sociodemographic and behavioural characteristics with use of a questionnaire at baseline and, for HIV-seronegative individuals, 6 months later. We calculated HIV incidence with Poisson regression modelling as events per person-years × 100, and we assessed covariables as predictors with Cox proportional hazards modelling. Survey weighting was applied and all models used survey sampling methods. FINDINGS: Between Dec 10, 2010, and June 25, 2011, 11 897 HIV-seronegative adults were enrolled in SHIMS and 11 232 (94%) were re-tested. Of these, 145 HIV seroconversions were observed, resulting in a weighted HIV incidence of 2·4% (95% CI 2·1-2·8). Incidence was nearly twice as high in women (3·1%; 95% CI 2·6-3·7) as in men (1·7%; 1·3-2·1, p<0·0001). Among men, partner's HIV-positive status (adjusted hazard ratio [aHR] 2·67, 1·06-6·82, p=0·040) or unknown serostatus (aHR 4·64, 2·32-9·27, p<0·0001) in the past 6 months predicted HIV seroconversion. Among women, significant predictors included not being married (aHR 2·90, 1·44-5·84, p=0·0030), having a spouse who lives elsewhere (aHR 2·66, 1·29-5·45, p=0·0078), and having a partner in the past 6 months with unknown HIV status (aHR 2·87, 1·44-5·84, p=0·0030). INTERPRETATION: Swaziland has the highest national HIV incidence in the world. In high-prevalence countries, population-based incidence measures and programmes that further expand HIV testing and support disclosure of HIV status are needed. FUNDING: President's Emergency Plan for AIDS Relief (PEPFAR) by the Centers for Disease Control and Prevention.
BACKGROUND: Swaziland has the highest national HIV prevalence worldwide. The Swaziland HIV Incidence Measurement Survey (SHIMS) provides the first national HIV incidence estimate based on prospectively observed HIV seroconversions. METHODS: A two-stage survey sampling design was used to select a nationally representative sample of men and women aged 18-49 years from 14 891 households in 575 enumeration areas in Swaziland, who underwent household-based counselling and rapid HIV testing during 2011. All individuals aged 18-49 years who resided or had slept in the household the night before and were willing to undergo home-based HIV testing, answer demographic and behavioural questions in English or siSwati, and provide written informed consent were eligible for the study. We performed rapid HIV testing and assessed sociodemographic and behavioural characteristics with use of a questionnaire at baseline and, for HIV-seronegative individuals, 6 months later. We calculated HIV incidence with Poisson regression modelling as events per person-years × 100, and we assessed covariables as predictors with Cox proportional hazards modelling. Survey weighting was applied and all models used survey sampling methods. FINDINGS: Between Dec 10, 2010, and June 25, 2011, 11 897 HIV-seronegative adults were enrolled in SHIMS and 11 232 (94%) were re-tested. Of these, 145 HIV seroconversions were observed, resulting in a weighted HIV incidence of 2·4% (95% CI 2·1-2·8). Incidence was nearly twice as high in women (3·1%; 95% CI 2·6-3·7) as in men (1·7%; 1·3-2·1, p<0·0001). Among men, partner's HIV-positive status (adjusted hazard ratio [aHR] 2·67, 1·06-6·82, p=0·040) or unknown serostatus (aHR 4·64, 2·32-9·27, p<0·0001) in the past 6 months predicted HIV seroconversion. Among women, significant predictors included not being married (aHR 2·90, 1·44-5·84, p=0·0030), having a spouse who lives elsewhere (aHR 2·66, 1·29-5·45, p=0·0078), and having a partner in the past 6 months with unknown HIV status (aHR 2·87, 1·44-5·84, p=0·0030). INTERPRETATION: Swaziland has the highest national HIV incidence in the world. In high-prevalence countries, population-based incidence measures and programmes that further expand HIV testing and support disclosure of HIV status are needed. FUNDING: President's Emergency Plan for AIDS Relief (PEPFAR) by the Centers for Disease Control and Prevention.
Authors: Yen T Duong; Yvonne Mavengere; Hetal Patel; Carole Moore; Julius Manjengwa; Dumile Sibandze; Christopher Rasberry; Charmaine Mlambo; Zhi Li; Lynda Emel; Naomi Bock; Jan Moore; Rejoice Nkambule; Jessica Justman; Jason Reed; George Bicego; Dennis L Ellenberger; John N Nkengasong; Bharat S Parekh Journal: J Clin Microbiol Date: 2014-08-13 Impact factor: 5.948
Authors: Jared M Baeten; Deborah Donnell; Patrick Ndase; Nelly R Mugo; James D Campbell; Jonathan Wangisi; Jordan W Tappero; Elizabeth A Bukusi; Craig R Cohen; Elly Katabira; Allan Ronald; Elioda Tumwesigye; Edwin Were; Kenneth H Fife; James Kiarie; Carey Farquhar; Grace John-Stewart; Aloysious Kakia; Josephine Odoyo; Akasiima Mucunguzi; Edith Nakku-Joloba; Rogers Twesigye; Kenneth Ngure; Cosmas Apaka; Harrison Tamooh; Fridah Gabona; Andrew Mujugira; Dana Panteleeff; Katherine K Thomas; Lara Kidoguchi; Meighan Krows; Jennifer Revall; Susan Morrison; Harald Haugen; Mira Emmanuel-Ogier; Lisa Ondrejcek; Robert W Coombs; Lisa Frenkel; Craig Hendrix; Namandjé N Bumpus; David Bangsberg; Jessica E Haberer; Wendy S Stevens; Jairam R Lingappa; Connie Celum Journal: N Engl J Med Date: 2012-07-11 Impact factor: 91.245
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: Christopher D Pilcher; J Todd McPherson; Peter A Leone; Marlene Smurzynski; Judy Owen-O'Dowd; Amy L Peace-Brewer; Juanita Harris; Charles B Hicks; Joseph J Eron; Susan A Fiscus Journal: JAMA Date: 2002-07-10 Impact factor: 56.272
Authors: Yen T Duong; Maofeng Qiu; Anindya K De; Keisha Jackson; Trudy Dobbs; Andrea A Kim; John N Nkengasong; Bharat S Parekh Journal: PLoS One Date: 2012-03-27 Impact factor: 3.240
Authors: Jacob Konikoff; Ron Brookmeyer; Andrew F Longosz; Matthew M Cousins; Connie Celum; Susan P Buchbinder; George R Seage; Gregory D Kirk; Richard D Moore; Shruti H Mehta; Joseph B Margolick; Joelle Brown; Kenneth H Mayer; Beryl A Koblin; Jessica E Justman; Sally L Hodder; Thomas C Quinn; Susan H Eshleman; Oliver Laeyendecker Journal: PLoS One Date: 2013-12-27 Impact factor: 3.240
Authors: Reshma Kassanjee; Christopher D Pilcher; Sheila M Keating; Shelley N Facente; Elaine McKinney; Matthew A Price; Jeffrey N Martin; Susan Little; Frederick M Hecht; Esper G Kallas; Alex Welte; Michael P Busch; Gary Murphy Journal: AIDS Date: 2014-10-23 Impact factor: 4.177
Authors: Oliver Laeyendecker; Ronald H Gray; M Kate Grabowski; Steven J Reynolds; Anthony Ndyanabo; Joseph Ssekasanvu; Reinaldo E Fernandez; Maria J Wawer; David Serwadda; Thomas C Quinn Journal: AIDS Res Hum Retroviruses Date: 2019-01-29 Impact factor: 2.205
Authors: Joseph Kagaayi; Larry W Chang; Victor Ssempijja; M Kate Grabowski; Robert Ssekubugu; Gertrude Nakigozi; Godfrey Kigozi; David M Serwadda; Ronald H Gray; Fred Nalugoda; Nelson K Sewankambo; Lisa Nelson; Lisa A Mills; Donna Kabatesi; Stella Alamo; Caitlin E Kennedy; Aaron A R Tobian; John S Santelli; Anna Mia Ekström; Helena Nordenstedt; Thomas C Quinn; Maria J Wawer; Steven J Reynolds Journal: Lancet HIV Date: 2019-09-15 Impact factor: 12.767
Authors: Bharat S Parekh; Chin-Yih Ou; Peter N Fonjungo; Mireille B Kalou; Erin Rottinghaus; Adrian Puren; Heather Alexander; Mackenzie Hurlston Cox; John N Nkengasong Journal: Clin Microbiol Rev Date: 2018-11-28 Impact factor: 26.132
Authors: Rebecca Fielding-Miller; Kristin L Dunkle; Hannah L F Cooper; Michael Windle; Craig Hadley Journal: Soc Sci Med Date: 2015-11-22 Impact factor: 4.634