Faith Ussery1, Pamela Bachanas1, Mary Grace Alwano2, Refeletswe Lebelonyane3, Lisa Block4, Kathleen Wirth5, Gene Ussery4, Baraedi Sento6, Tendani Gaolathe7, Etienne Kadima7, William Abrams2, Tebogo Segolodi2, Shannon Hader8, Shahin Lockman5,7,9, Janet Moore1. 1. Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. 2. Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Gaborone, Botswana. 3. Botswana Ministry of Health, Gaborone, Botswana. 4. Northrop Grumman, Atlanta, GA. 5. Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA. 6. Tebelopele HIV Testing and Counseling Center, Gaborone, Botswana. 7. Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana. 8. UNAIDS, Geneva, Switzerland; and. 9. Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Abstract
BACKGROUND AND SETTING: The Botswana Combination Prevention Project demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. We report rates and characteristics of incident HIV infections. METHODS: The Botswana Combination Prevention Project was a community-randomized controlled trial conducted in 30 rural/periurban Botswana communities from 2013 to 2017. Home-based and mobile HIV-testing campaigns were conducted in 15 intervention communities, with 39% of participants testing at least twice. We assessed the HIV incidence rate [IR; number of new HIV infections per 100 person-years (py) at risk] among repeat testers and risk factors with a Cox proportional hazards regression model. RESULTS: During 27,517 py, 195 (women: 79%) of 18,597 became HIV-infected (0.71/100 py). Women had a higher IR (1.01/100 py; 95% confidence interval: 0.99 to 1.02) than men (0.34/100 py; 95% confidence interval: 0.33 to 0.35). The highest IRs were among women aged 16-24 years (1.87/100 py) and men aged 25-34 years (0.56/100 py). The lowest IRs were among those aged 35-64 years (women: 0.41/100 py; men: 0.20/100 py). The hazard of incident infection was the highest among women aged 16-24 years (hazard ratio = 7.05). Sex and age were significantly associated with incidence (both P < 0.0001). CONCLUSIONS: Despite an overall reduction in HIV incidence and approaching the United Nations Programme on HIV/AIDS 95-95-95 targets, high HIV incidence was observed in adolescent girls and young women. These findings highlight the need for additional prevention services (pre-exposure prophylaxis and DREAMS) to achieve epidemic control in this subpopulation and increased efforts with men with undiagnosed HIV.
BACKGROUND AND SETTING: The Botswana Combination Prevention Project demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. We report rates and characteristics of incident HIV infections. METHODS: The Botswana Combination Prevention Project was a community-randomized controlled trial conducted in 30 rural/periurban Botswana communities from 2013 to 2017. Home-based and mobile HIV-testing campaigns were conducted in 15 intervention communities, with 39% of participants testing at least twice. We assessed the HIV incidence rate [IR; number of new HIV infections per 100 person-years (py) at risk] among repeat testers and risk factors with a Cox proportional hazards regression model. RESULTS: During 27,517 py, 195 (women: 79%) of 18,597 became HIV-infected (0.71/100 py). Women had a higher IR (1.01/100 py; 95% confidence interval: 0.99 to 1.02) than men (0.34/100 py; 95% confidence interval: 0.33 to 0.35). The highest IRs were among women aged 16-24 years (1.87/100 py) and men aged 25-34 years (0.56/100 py). The lowest IRs were among those aged 35-64 years (women: 0.41/100 py; men: 0.20/100 py). The hazard of incident infection was the highest among women aged 16-24 years (hazard ratio = 7.05). Sex and age were significantly associated with incidence (both P < 0.0001). CONCLUSIONS: Despite an overall reduction in HIV incidence and approaching the United Nations Programme on HIV/AIDS 95-95-95 targets, high HIV incidence was observed in adolescent girls and young women. These findings highlight the need for additional prevention services (pre-exposure prophylaxis and DREAMS) to achieve epidemic control in this subpopulation and increased efforts with men with undiagnosed HIV.
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Authors: Tafireyi Marukutira; Lisa Block; Mary Grace Alwano; Stephanie Behel; Joseph N Jarvis; Unoda Chakalisa; Kate Powis; Vladimir Novitsky; William Bapati; Huisheng Wang; Faith Ussery; Refeletswe Lebelonyane; Lisa A Mills; Janet Moore; Pamela Bachanas Journal: PLoS One Date: 2019-08-29 Impact factor: 3.240