Evidence for localised HIV related micro–epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio–temporal analysis of changing mortality patterns (2007–2010)

Mee, Paul; Collinson, Mark; Madhavan, Sangeetha; Root, Elisabeth Dowling; Tollman, Stephen; Byass, Peter; Kahn, Kathleen

doi:10.7189/jogh.04.010403

Cited by 27 publications

(29 citation statements)

References 41 publications

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“…However, this study’s participation rates are comparable or higher than in similar community cohort studies in Africa, 27 , 28 cohort findings are largely consistent with Uganda DHS data on HIV prevalence and risk factors for the larger south-central region of Uganda, 29 and other countries appear to have similarly complex HIV epidemics. 30 This study also utilized self-reports of behaviors, ART, and male circumcision which may be subject to respondent desirability bias. Additionally, for this analysis, we used cross-sectional survey data collected over a two year period and results may have been subject to secular changes.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

et al. 2016

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SummaryBackgroundUnderstanding the extent to which HIV burden differs across communities and the drivers of local disparities is critical for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in Rakai, Uganda.MethodsThe Rakai Community Cohort Study (RCCS) is an open, population-based cohort surveying persons aged 15–49 in 40 communities. Participants are HIV tested and interviewed to obtain sociodemographic, behavioral, and health information. RCCS data from August 2011 to May 2013 were used to classify communities as agrarian (n=27), trading (n=9), or lakeside fishing sites (n=4). HIV prevalence was mapped using Bayesian methods, and variability across and within community classifications was characterized. Differences in HIV risk factors and uptake of antiretroviral therapy and male circumcision between community types were assessed.Findings17,119 individuals were included; 9215 (54%) were female. 9931 participants resided in agrarian, 3318 in trading, and 3870 in fishing communities. There was large variation in HIV prevalence, ranging from 9% to 43% across communities. Fishing communities had a higher median HIV prevalence (41%, range: 37–43%) compared to trading (17%, range: 11–22%) and agrarian communities (14%, range: 9–26%); ART and male circumcision coverage were significantly lower in fishing communities. Self-reported risk behaviors were significantly higher in men compared to women and in fishing communities compared to other community types.InterpretationThere is substantial heterogeneity in HIV prevalence, risk factors, and service uptake across communities within one region of Uganda. These findings underscore the need for local surveillance and have important implications for the design of targeted HIV responses. In particular, the extremely high HIV burden and risk behaviors, and low use of combination HIV prevention in fishing communities make these areas a priority for intervention.

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Section: Discussionmentioning

confidence: 99%

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

et al. 2016

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“…8 But increased access to HAART presents special challenges in diagnosing new in-fections, monitoring of the epidemic, and managing subepidemics as new or mutant virus strains appear in circulation. 9 We recently reported on HIV subtype variability in Kenyan HAART patients based on envelope sequences. 10 The epidemiologic architecture of the Kenyan epidemic displays characteristic variability at both genetic and geographic levels, with HIV-A dominating, although at a declining prevalence.…”

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confidence: 99%

Genotypic Variability of HIV-1 Reverse Transcriptase Gene from Long-Term Antiretroviral-Experienced Patients in Kenya

Nzomo

Kitawi

Mwatelah

et al. 2015

AIDS Research and Human Retroviruses

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There is continuous need to track genetic profiles of HIV strains circulating in different geographic settings to hasten vaccine discovery and inform public health and intervention policies. We partially sequenced the reverse transcriptase region of the HIV-1 pol gene from a total of 54 Kenyan patients aged 18-56 years who continued highly active antiretroviral treatment (HAART) for between 8 and 102 months. Subtyping was done using both the JPHMM tool and phylogenetic method. HIV-1 subtype A1 was the predominant strain in circulation, representing 57.4% and 70.4% of all isolates as determined by JPHMM and phylogenetic methods, respectively. Subtypes D (14.8%, 7.4%), C (5.6%, 9.3%), and A2 (0%, 5.6%) were determined at respective prevalence by both methods. JPHMM identified 22.2% of the isolates as recombinants. This surveillance focused on the RT gene and reaffirms the predominance of subtype A and an increasing proportion of recombinant strains in the Kenyan epidemic.

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“…The study was carried out in the Agincourt sub-district which is underpinned by a robust Health and Demographic Surveillance System (HDSS) and is located in the Bushbuckridge area of Ehlanzeni municipality of Mpumalanga Province in North-East South Africa. The sub-district has a predominantly rural character with nearby peri-urban settlements [ 14 , 16 , 17 ] and is close to the southern Mozambican border. There are strong familial and cultural links between the region and Mozambique and approximately one-third of the population are of Mozambican origin [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…Studies in this area using data from 1992 to 2007 identified distinct localised clusters of all-cause and cause-specific mortality [ 13 ]. A recent study assessed changes in HIV/AIDS related mortality over the period of the roll-out of ART in this community [ 14 ]. This study found a 30% decrease in adult HIV-related mortality between 2007 and 2008, the period immediately before Antiretroviral therapy (ART) was easily accessible in this area, and 2009–2010.…”

Section: Hiv Mortality Studies In the Agincourt Sub-districtmentioning

confidence: 99%

The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa

Mee

Kahn

Kabudula

et al. 2016

Glob. Health Epidemiol.

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The human immunodeficiency virus (HIV) epidemic in South Africa rapidly developed into a major pandemic. Here we analyse the development of the epidemic in a rural area of the country. The data used were collected between 1992 and 2013 in a longitudinal population survey, the Agincourt Health and Demographic Surveillance Study, in the northeast of the country. Throughout the period of study mortality rates were similar in all villages, suggesting that there were multiple index cases evenly spread geographically. These were likely to have been returning migrant workers. For those aged below 39 years the HIV mortality rate was higher for women, above this age it was higher for men. This indicates the protective effect of greater access to HIV testing and treatment among older women. The recent convergence of mortality rates for Mozambicans and South Africans indicates that the former refugee population are being assimilated into the host community. More than 60% of the deaths occurring in this community between 1992 and 2013 could be attributed directly or indirectly to HIV. Recently there has been an increasing level of non-HIV mortality which has important implications for local healthcare provision. This study demonstrates how evidence from longitudinal analyses can support healthcare planning.

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Evidence for localised HIV related micro–epidemics associated with the decentralised provision of antiretroviral treatment in rural South Africa: a spatio–temporal analysis of changing mortality patterns (2007–2010)

Cited by 27 publications

References 41 publications

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Genotypic Variability of HIV-1 Reverse Transcriptase Gene from Long-Term Antiretroviral-Experienced Patients in Kenya

The development of a localised HIV epidemic and the associated excess mortality burden in a rural area of South Africa

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