Ayesha B M Kharsany1, Cherie Cawood2, David Khanyile2, Lara Lewis3, Anneke Grobler3, Adrian Puren4, Kaymarlin Govender5, Gavin George5, Sean Beckett5, Natasha Samsunder3, Savathree Madurai6, Carlos Toledo7, Zawadi Chipeta8, Mary Glenshaw9, Sara Hersey10, Quarraisha Abdool Karim11. 1. Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. Electronic address: Ayesha.Kharsany@caprisa.org. 2. Epicentre AIDs Risk Management (Pty) Limited, Cape Town, South Africa. 3. Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. 4. Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa. 5. Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa. 6. Global Clinical and Virology Laboratory, Amanzimtoti, South Africa. 7. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. 8. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa; BroadReach, Cape Town, South Africa. 9. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa. 10. Centers for Disease Control and Prevention (CDC), Pretoria, South Africa; Centers for Disease Control and Prevention (CDC), Freetown, Sierra Leone. 11. Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Department of Epidemiology, Columbia University, New York, NY, USA.
Abstract
BACKGROUND: In high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities. METHODS: We did a cross-sectional community survey in the adjacent Greater Edendale and Vulindlela areas in the uMgungundlovu district, KwaZulu-Natal, South Africa. Using a multistage cluster sampling method, we randomly selected enumeration areas, households, and individuals. One household member (aged 15-49 years) selected at random was invited for survey participation. After obtaining consent, questionnaires were administered to obtain sociodemographic, psychosocial, and behavioural information, and exposure to HIV prevention and treatment programmes. Clinical samples were collected for laboratory measurements. Statistical analyses were done accounting for multilevel sampling and weighted to represent the population. A multivariable logistic regression model assessed factors associated with HIV infection. FINDINGS: Between June 11, 2014, and June 22, 2015, we enrolled 9812 individuals. The population-weighted HIV prevalence was 36·3% (95% CI 34·8-37·8, 3969 of 9812); 44·1% (42·3-45·9, 2955 of 6265) in women and 28·0% (25·9-30·1, 1014 of 3547) in men (p<0·0001). HIV prevalence in women aged 15-24 years was 22·3% (20·2-24·4, 567 of 2224) compared with 7·6% (6·0-9·3, 124 of 1472; p<0·0001) in men of the same age. Prevalence peaked at 66·4% (61·7-71·2, 517 of 760) in women aged 35-39 years and 59·6% (53·0-66·3, 183 of 320) in men aged 40-44 years. Consistent condom use in the last 12 months was 26·5% (24·1-28·8, 593 of 2356) in men and 22·7% (20·9-24·4, 994 of 4350) in women (p=0·0033); 35·7% (33·4-37·9, 1695 of 5447) of women's male partners and 31·9% (29·5-34·3, 1102 of 3547) of men were medically circumcised (p<0·0001), and 45·6% (42·9-48·2, 1251 of 2955) of women and 36·7% (32·3-41·2, 341 of 1014) of men reported antiretroviral therapy (ART) use (p=0·0003). HIV viral suppression was achieved in 54·8% (52·0-57·5, 1574 of 2955) of women and 41·9% (37·1-46·7, 401 of 1014) of men (p<0·0001), and 87·2% (84·6-89·8, 1086 of 1251) of women and 83·9% (78·5-89·3, 284 of 341; p=0·3670) of men on ART. Age, incomplete secondary schooling, being single, having more than one lifetime sex partner (women), sexually transmitted infections, and not being medically circumcised were associated with HIV-positive status. INTERPRETATION: The HIV burden in specific age groups, the suboptimal differential coverage, and uptake of HIV prevention strategies justifies a location-based approach to surveillance with finer disaggregation by age and sex. Intensified and customised approaches to seek, identify, and link individuals to HIV services are crucial to achieving epidemic control in this community. FUNDING: The President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.
BACKGROUND: In high HIV burden settings, maximising the coverage of prevention strategies is crucial to achieving epidemic control. However, little is known about the reach and effect of these strategies in some communities. METHODS: We did a cross-sectional community survey in the adjacent Greater Edendale and Vulindlela areas in the uMgungundlovu district, KwaZulu-Natal, South Africa. Using a multistage cluster sampling method, we randomly selected enumeration areas, households, and individuals. One household member (aged 15-49 years) selected at random was invited for survey participation. After obtaining consent, questionnaires were administered to obtain sociodemographic, psychosocial, and behavioural information, and exposure to HIV prevention and treatment programmes. Clinical samples were collected for laboratory measurements. Statistical analyses were done accounting for multilevel sampling and weighted to represent the population. A multivariable logistic regression model assessed factors associated with HIV infection. FINDINGS: Between June 11, 2014, and June 22, 2015, we enrolled 9812 individuals. The population-weighted HIV prevalence was 36·3% (95% CI 34·8-37·8, 3969 of 9812); 44·1% (42·3-45·9, 2955 of 6265) in women and 28·0% (25·9-30·1, 1014 of 3547) in men (p<0·0001). HIV prevalence in women aged 15-24 years was 22·3% (20·2-24·4, 567 of 2224) compared with 7·6% (6·0-9·3, 124 of 1472; p<0·0001) in men of the same age. Prevalence peaked at 66·4% (61·7-71·2, 517 of 760) in women aged 35-39 years and 59·6% (53·0-66·3, 183 of 320) in men aged 40-44 years. Consistent condom use in the last 12 months was 26·5% (24·1-28·8, 593 of 2356) in men and 22·7% (20·9-24·4, 994 of 4350) in women (p=0·0033); 35·7% (33·4-37·9, 1695 of 5447) of women's male partners and 31·9% (29·5-34·3, 1102 of 3547) of men were medically circumcised (p<0·0001), and 45·6% (42·9-48·2, 1251 of 2955) of women and 36·7% (32·3-41·2, 341 of 1014) of men reported antiretroviral therapy (ART) use (p=0·0003). HIV viral suppression was achieved in 54·8% (52·0-57·5, 1574 of 2955) of women and 41·9% (37·1-46·7, 401 of 1014) of men (p<0·0001), and 87·2% (84·6-89·8, 1086 of 1251) of women and 83·9% (78·5-89·3, 284 of 341; p=0·3670) of men on ART. Age, incomplete secondary schooling, being single, having more than one lifetime sex partner (women), sexually transmitted infections, and not being medically circumcised were associated with HIV-positive status. INTERPRETATION: The HIV burden in specific age groups, the suboptimal differential coverage, and uptake of HIV prevention strategies justifies a location-based approach to surveillance with finer disaggregation by age and sex. Intensified and customised approaches to seek, identify, and link individuals to HIV services are crucial to achieving epidemic control in this community. FUNDING: The President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.
Authors: Sabin Nsanzimana; Steve Kanters; Eric Remera; Jamie I Forrest; Agnes Binagwaho; Jeanine Condo; Edward J Mills Journal: Lancet HIV Date: 2015-03-27 Impact factor: 12.767
Authors: T C Quinn; M J Wawer; N Sewankambo; D Serwadda; C Li; F Wabwire-Mangen; M O Meehan; T Lutalo; R H Gray Journal: N Engl J Med Date: 2000-03-30 Impact factor: 91.245
Authors: Tendani Gaolathe; Kathleen E Wirth; Molly Pretorius Holme; Joseph Makhema; Sikhulile Moyo; Unoda Chakalisa; Etienne Kadima Yankinda; Quanhong Lei; Mompati Mmalane; Vlad Novitsky; Lillian Okui; Erik van Widenfelt; Kathleen M Powis; Nealia Khan; Kara Bennett; Hermann Bussmann; Scott Dryden-Peterson; Refeletswe Lebelonyane; Shenaaz El-Halabi; Lisa A Mills; Tafireyi Marukutira; Rui Wang; Eric J Tchetgen Tchetgen; Victor DeGruttola; M Essex; Shahin Lockman Journal: Lancet HIV Date: 2016-03-24 Impact factor: 12.767
Authors: Alexandra Jones; Ide Cremin; Fareed Abdullah; John Idoko; Peter Cherutich; Nduku Kilonzo; Helen Rees; Timothy Hallett; Kevin O'Reilly; Florence Koechlin; Bernhard Schwartlander; Barbara de Zalduondo; Susan Kim; Jonathan Jay; Jacqueline Huh; Peter Piot; Mark Dybul Journal: Lancet Date: 2014-04-14 Impact factor: 79.321
Authors: Lucie Dale Cluver; Frederick Mark Orkin; Franziska Meinck; Mark Edward Boyes; Lorraine Sherr Journal: J Int AIDS Soc Date: 2016-04-15 Impact factor: 5.396
Authors: Stéphanie Blaizot; Helena Huerga; Benjamin Riche; Tom Ellman; Amir Shroufi; Jean-François Etard; René Ecochard Journal: BMC Infect Dis Date: 2017-07-26 Impact factor: 3.090
Authors: Ayesha B M Kharsany; Cherie Cawood; David Khanyile; Anneke Grobler; Lyle R Mckinnon; Natasha Samsunder; Janet A Frohlich; Quarraisha Abdool Karim; Adrian Puren; Alex Welte; Gavin George; Kaymarlin Govender; Carlos Toledo; Zawadi Chipeta; Lycias Zembe; Mary T Glenshaw; Lorna Madurai; Varough M Deyde; Alfred Bere Journal: BMC Public Health Date: 2015-11-20 Impact factor: 3.295
Authors: Anna Grimsrud; Helen Bygrave; Meg Doherty; Peter Ehrenkranz; Tom Ellman; Robert Ferris; Nathan Ford; Bactrin Killingo; Lynette Mabote; Tara Mansell; Annette Reinisch; Isaac Zulu; Linda-Gail Bekker Journal: J Int AIDS Soc Date: 2016-12-01 Impact factor: 5.396
Authors: Benjamin Chimukangara; Ayesha B M Kharsany; Richard J Lessells; Kogieleum Naidoo; Soo-Yon Rhee; Justen Manasa; Tiago Gräf; Lara Lewis; Cherie Cawood; David Khanyile; Karidia Diallo; Kassahun A Ayalew; Robert W Shafer; Gillian Hunt; Deenan Pillay; Salim Karim Abdool; Tulio de Oliveira Journal: AIDS Res Hum Retroviruses Date: 2019-01-07 Impact factor: 2.205
Authors: Rachel S Gruver; Sumaya Mall; Jane D Kvalsvig; Justin R Knox; Claude A Mellins; Chris Desmond; Shuaib Kauchali; Stephen M Arpadi; Myra Taylor; Leslie L Davidson Journal: New Dir Child Adolesc Dev Date: 2020-07-03
Authors: Christina Psaros; Amelia M Stanton; Greer A Raggio; Nzwakie Mosery; Georgia R Goodman; Elsa S Briggs; Marcel Williams; David Bangsberg; Jenni Smit; Steven A Safren Journal: Int J Behav Med Date: 2022-03-08
Authors: Nonzwakazi P Ntombela; Ayesha B M Kharsany; Adenike Soogun; Nonhlanhla Yende-Zuma; Hans-Peter Kohler; Lyle R McKinnon Journal: AIDS Behav Date: 2021-02-11
Authors: Jerry John Nutor; Henry Ofori Duah; Pascal Agbadi; Precious Adade Duodu; Kaboni W Gondwe Journal: BMC Public Health Date: 2020-07-25 Impact factor: 3.295