Creating an African HIV Clinical Research and Prevention Trials Network: HIV Prevalence, Incidence and Transmission

Abstract

HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.

Feasibility of a Combination HIV Prevention Program for Men Who Have Sex With Men in Blantyre, Malawi

“…1,33 Seven participants seroconverted in the study and all seroconverted during the first study period. Though this is consistent with other incidence studies among MSM in African settings, 34 it could also be reflective of early, undetectable infection at enrollment or acquisition during the period when the study was temporarily closed. This study does demonstrate the feasibility of conducting longitudinal research in Blantyre and a larger trial could, if carefully implemented, be conducted among MSM to test the efficacy of other interventions, including biomedical interventions, and HIV outcomes.…”

Changes in sexual risk behavior among MSM participating in a research cohort in coastal Kenya

“…This suggests that our study population may represent a somewhat less risky group. However, HIV-1 incidences reported in this study population have been very high [5], especially in the first 3 months following cohort enrolment compared to the remainder of cohort follow-up (16.0 per 100 person-years in the first 3 months vs. 5.2 per 100 person-years in the remainder of follow-up), suggesting that risk of HIV-1 acquisition was very high in this group of MSM, and dropped along with reports of higher risk behaviors [23]. Third, some HIV-1-positive men were treated with antiretroviral therapy (ART) during the study, which may have influenced sexual risk behavior.…”

Comparison of HIV incidence estimated in clinical trial and observational cohort settings in a high risk fishing population in Uganda: Implications for sample size estimates

“…The investigators of the International AIDS Vaccine Initiative (IAVI) network in sub-Saharan Africa have been conducting a number of observational studies to assess the suitability and willingness of potential populations to enroll in future HIV vaccine efficacy trials[2]. Volunteers in these observational cohorts have included discordant couples, members of fishing communities, women at high risk, and men who have sex with men (MSM).…”

“…Volunteers in these observational cohorts have included discordant couples, members of fishing communities, women at high risk, and men who have sex with men (MSM). In these studies, annual HIV incidence ranged from 1.1 to 10.8 per 100 person years of observation (PYO) with one-year study retention of 75% to 97%[2] and HIV prevalence ranged from 8.3% to 16.4%[2]. These populations have also expressed a high willingness to enroll in future efficacy trials [3-5].…”