HIV incidence and prevalence among cohorts of women with higher risk behaviour in Bloemfontein and Rustenburg, South Africa: a prospective study

Abstract

ObjectivesThe primary objective was to measure HIV incidence in two prospective cohorts of HIV-negative women. Secondary objectives included measuring pregnancy rates and participant retention rates.DesignCross-sectional HIV screening of women selected for higher risk behaviours, with a subsequent prospective study of uninfected women, followed monthly for up to 6 months.SettingClinics established for research purposes in Bloemfontein and Rustenburg, South Africa.ParticipantsThe authors enrolled women 18–35 years old and presumed at higher risk of sexual acquisition of HIV as indicated by self-reported sexual behaviour or recent sexually transmitted infection symptoms. In Bloemfontein, 1364 women were screened, 1154 were eligible for HIV testing and 1145 agreed to be tested. The prospective study enrolled 401 HIV-negative women. In Rustenburg, 946 women were screened, 540 were eligible and underwent HIV testing and 223 HIV-negative women entered the prospective study.Primary and secondary outcomesBaseline prevalences of HIV infection and HIV incidence rates in the prospective cohorts, according to a double rapid test algorithm with a third rapid test for discrepant or indeterminate results. Pregnancy prevalences and pregnancy incidence rate in Bloemfontein. Participant retention rates in the prospective cohort until the study end.ResultsIn Bloemfontein, 1145 women were tested, 391 entered follow-up and 92.3% of participants completed six study visits. In Rustenburg, 540 women were tested, 194 entered follow-up and retention up to the point of early study termination was 88.6%. Overall HIV prevalence was 21.2% (95% CI 18.9% to 23.6%) in Bloemfontein and 23.5% (95% CI 19.9% to 27.1%) in Rustenburg. Overall HIV incidence was 5.5/100 person-years (95% CI 2.5 to 10.4) in Bloemfontein and 3.0/100 person-years (95% CI 0.4 to 10.8) in Rustenburg. Cross-sectional pregnancy prevalences were 6.5% in Bloemfontein and 8.6% in Rustenburg.ConclusionsThe authors observed substantial HIV incidence rates in both cohorts. Vigorous prevention efforts are needed in these smaller cities.

The Epidemiology of HIV and HSV-2 Infections among Women Participating in Microbicide and Vaccine Feasibility Studies in Northern Tanzania

“…The HIV incidence observed in this study was comparable to similar cohorts in Moshi and Mwanza, Tanzania, and South Africa [4]–[6], [19], but lower than that observed in another similar cohort in Mbeya, Tanzania [22] and among women from the general population in South Africa [23], [24]. The HSV-2 incidence was higher than that observed in similar cohorts in Moshi and Mwanza [5], [25], but comparable to Kenyan women with high-risk sexual behaviour [26], [27] and women attending sexual health clinics in Alabama, US [28].…”

“…As observed in other studies [15], [17]–[19], the prevalence of HIV and HSV-2 infections was higher in older participants, due to age being a proxy measure of the duration of sexual activity and these being life-long infections. Women who were separated, divorced, or widowed had the highest prevalence of both infections.…”

The need for multipurpose prevention technologies in sub‐Saharan Africa

“…These exceptionally high HIV prevalence rates are being sustained by high HIV incidence rates among young women. Several cohort studies have been conducted in South Africa to measure HIV incidence . Results from one of these cohort studies conducted between 2002 and 2005 in preparation for a microbicide trial showed that the HIV incidence rate was 6.6 per 100 person‐years.…”

Molecular Validation of Putative Antimicrobial Peptides for Improved Human Immunodeficiency Virus Diagnostics via HIV Protein p24

“…This accounts for 60% of the world's HIV population. Swaziland has the world's largest prevalence rate (25.9%) whereas South Africa is known to have the world largest HIV infected population (5.6 million) [7]. This statistics are attributed to the poor current treatment regiments and the ineffective diagnostic systems.…”