BACKGROUND: In Kenya, coverage of antiretroviral therapy (ART) among people with HIV infection has increased from 7% in 2006, to 57% in 2016; and, in western Kenya, coverage of voluntary medical male circumcision (VMMC) increased from 45% in 2008, to 72% in 2014. We investigated trends in HIV prevalence and incidence in a high burden area in western Kenya in 2011-16. METHODS: In 2011, 2012, and 2016, population-based surveys were done via a health and demographic surveillance system and home-based counselling and testing in Gem, Siaya County, Kenya, including 28 688, 17 021, and 16 772 individuals aged 15-64 years. Data on demographic variables, self-reported HIV status, and risk factors were collected. Rapid HIV testing was offered to survey participants. Participants were tracked between surveys by use of health and demographic surveillance system identification numbers. HIV prevalence was calculated as a proportion, and HIV incidence was expressed as number of new infections per 1000 person-years of follow-up. FINDINGS: HIV prevalence was stable in participants aged 15-64 years: 15% (4300/28 532) in 2011, 12% (2051/16 875) in 2012, and 15% (2312/15 626) in 2016. Crude prevalences in participants aged 15-34 years were 11% (1893/17 197) in 2011, 10% (1015/10 118) in 2012, and 9% (848/9125) in 2016; adjusted for age and sex these prevalences were 11%, 9%, and 8%. 12 606 (41%) of the 30 520 non-HIV-infected individuals enrolled were seen again in at least one more survey round, and were included in the analysis of HIV incidence. HIV incidence was 11·1 (95% CI 9·1-13·1) per 1000 person-years from 2011 to 2012, and 5·7 (4·6-6·9) per 1000 person-years from 2012 to 2016. INTERPRETATION: With increasing coverage of ART and VMMC, HIV incidence declined substantially in Siaya County between 2011 and 2016. VMMC, but not ART, was suggested to have a direct protective effect, presumably because ART tended to be given to individuals with advanced HIV infection. HIV incidence is still high and not close to the elimination target of one per 1000 person-years. The effect of further scale-up of ART and VMMC needs to be monitored. FUNDING: Data were collected under Cooperative Agreements with the US Centers for Disease Control and Prevention, with funding from the President's Emergency Fund for AIDS Relief.
BACKGROUND: In Kenya, coverage of antiretroviral therapy (ART) among people with HIV infection has increased from 7% in 2006, to 57% in 2016; and, in western Kenya, coverage of voluntary medical male circumcision (VMMC) increased from 45% in 2008, to 72% in 2014. We investigated trends in HIV prevalence and incidence in a high burden area in western Kenya in 2011-16. METHODS: In 2011, 2012, and 2016, population-based surveys were done via a health and demographic surveillance system and home-based counselling and testing in Gem, Siaya County, Kenya, including 28 688, 17 021, and 16 772 individuals aged 15-64 years. Data on demographic variables, self-reported HIV status, and risk factors were collected. Rapid HIV testing was offered to survey participants. Participants were tracked between surveys by use of health and demographic surveillance system identification numbers. HIV prevalence was calculated as a proportion, and HIV incidence was expressed as number of new infections per 1000 person-years of follow-up. FINDINGS: HIV prevalence was stable in participants aged 15-64 years: 15% (4300/28 532) in 2011, 12% (2051/16 875) in 2012, and 15% (2312/15 626) in 2016. Crude prevalences in participants aged 15-34 years were 11% (1893/17 197) in 2011, 10% (1015/10 118) in 2012, and 9% (848/9125) in 2016; adjusted for age and sex these prevalences were 11%, 9%, and 8%. 12 606 (41%) of the 30 520 non-HIV-infected individuals enrolled were seen again in at least one more survey round, and were included in the analysis of HIV incidence. HIV incidence was 11·1 (95% CI 9·1-13·1) per 1000 person-years from 2011 to 2012, and 5·7 (4·6-6·9) per 1000 person-years from 2012 to 2016. INTERPRETATION: With increasing coverage of ART and VMMC, HIV incidence declined substantially in Siaya County between 2011 and 2016. VMMC, but not ART, was suggested to have a direct protective effect, presumably because ART tended to be given to individuals with advanced HIV infection. HIV incidence is still high and not close to the elimination target of one per 1000 person-years. The effect of further scale-up of ART and VMMC needs to be monitored. FUNDING: Data were collected under Cooperative Agreements with the US Centers for Disease Control and Prevention, with funding from the President's Emergency Fund for AIDS Relief.
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: Katrina F Ortblad; Jared M Baeten; Peter Cherutich; Joyce Njeri Wamicwe; Judith N Wasserheit Journal: Curr Opin HIV AIDS Date: 2019-09 Impact factor: 4.283
Authors: Godfrey M Bigogo; Allan Audi; Joshua Auko; George O Aol; Benjamin J Ochieng; Herine Odiembo; Arthur Odoyo; Marc-Alain Widdowson; Clayton Onyango; Martien W Borgdorff; Daniel R Feikin; Maria da Gloria Carvalho; Cynthia G Whitney; Jennifer R Verani Journal: Clin Infect Dis Date: 2019-11-27 Impact factor: 9.079
Authors: Diane V Havlir; Laura B Balzer; Edwin D Charlebois; Tamara D Clark; Dalsone Kwarisiima; James Ayieko; Jane Kabami; Norton Sang; Teri Liegler; Gabriel Chamie; Carol S Camlin; Vivek Jain; Kevin Kadede; Mucunguzi Atukunda; Theodore Ruel; Starley B Shade; Emmanuel Ssemmondo; Dathan M Byonanebye; Florence Mwangwa; Asiphas Owaraganise; Winter Olilo; Douglas Black; Katherine Snyman; Rachel Burger; Monica Getahun; Jackson Achando; Benard Awuonda; Hellen Nakato; Joel Kironde; Samuel Okiror; Harsha Thirumurthy; Catherine Koss; Lillian Brown; Carina Marquez; Joshua Schwab; Geoff Lavoy; Albert Plenty; Erick Mugoma Wafula; Patrick Omanya; Yea-Hung Chen; James F Rooney; Melanie Bacon; Mark van der Laan; Craig R Cohen; Elizabeth Bukusi; Moses R Kamya; Maya Petersen Journal: N Engl J Med Date: 2019-07-18 Impact factor: 91.245
Authors: Kathrine A Schilling; Alex O Awuor; Anu Rajasingham; Fenny Moke; Richard Omore; Manase Amollo; Tamer H Farag; Dilruba Nasrin; James P Nataro; Karen L Kotloff; Myron M Levine; Tracy Ayers; Kayla Laserson; Anna Blackstock; Richard Rothenberg; Christine E Stauber; Eric D Mintz; Robert F Breiman; Ciara E O'Reilly Journal: Am J Trop Med Hyg Date: 2018-10 Impact factor: 2.345
Authors: Winnie Kavulani Luseno; Samuel H Field; Bonita J Iritani; Fredrick S Odongo; Daniel Kwaro; Nyaguara Ombek Amek; Stuart Rennie Journal: AIDS Behav Date: 2021-05
Authors: Kathryn A Risher; Anne Cori; Georges Reniers; Milly Marston; Clara Calvert; Amelia Crampin; Tawanda Dadirai; Albert Dube; Simon Gregson; Kobus Herbst; Tom Lutalo; Louisa Moorhouse; Baltazar Mtenga; Dorean Nabukalu; Robert Newton; Alison J Price; Malebogo Tlhajoane; Jim Todd; Keith Tomlin; Mark Urassa; Alain Vandormael; Christophe Fraser; Emma Slaymaker; Jeffrey W Eaton Journal: Lancet HIV Date: 2021-07 Impact factor: 12.767
Authors: Adam Akullian; Alain Vandormael; Joel C Miller; Anna Bershteyn; Edward Wenger; Diego Cuadros; Dickman Gareta; Till Bärnighausen; Kobus Herbst; Frank Tanser Journal: Proc Natl Acad Sci U S A Date: 2021-07-13 Impact factor: 12.779