Putting women in the centre of the global HIV response is key to achieving epidemic control!

Karim, Quarraisha Abdool; Havlir, Diane V.; Phanuphak, Nittaya

doi:10.1002/jia2.25473

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…10 Some stakeholders have raised concerns that these approaches neglect women aged 25–34 years with high HIV incidence rates, and they encourage the provision of HIV prevention for women of all ages. 28 For men, questions persist about the short-term and long-term value of promoting voluntary medical male circumcision among different age groups. 29 …”

Section: Discussionmentioning

confidence: 99%

Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies

et al. 2021

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Background As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in mean age at infection, age distribution of new infections, and birth cohort cumulative incidence. MethodsWe used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals' HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe, in a collaborative analysis of the ALPHA network. We modelled HIV incidence rates by age, time, and sex using smoothing splines functions. We estimated incidence trends separately by sex and study. We used estimated incidence and prevalence results for 2000-17, standardised to study population distribution, to estimate mean age at infection and proportion of new infections by age. We also estimated cumulative incidence (lifetime risk of infection) by birth cohort.Findings Age-specific incidence declined at all ages, although the timing and pattern of decline varied by study. The mean age at infection was higher in men (cohort mean 27•8-34•6 years) than in women (24•8-29•6 years). Between 2000 and 2017, the mean age at infection per cohort increased slightly: 0•5 to 2•8 years among men and -0•2 to 2•5 years among women. Across studies, between 38% and 63% (cohort medians) of the infections in women were among those aged 15-24 years and between 30% and 63% of infections in men were in those aged 20-29 years. Lifetime risk of HIV declined for successive birth cohorts.Interpretation HIV incidence declined in all age groups and shifted slightly to older ages. Disproportionate new HIV infections occur among women aged 15-24 years and men aged 20-29 years, supporting focused prevention in these groups. However, 40-60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages.Funding Bill & Melinda Gates Foundation.

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Section: Discussionmentioning

confidence: 99%

Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies

et al. 2021

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“…Treatment-as-prevention (TasP) was one of the primary rationales for “Test-and-Treat”, the now widespread policy of starting ART at diagnosis regardless of CD4 count or disease stage [ 7 ], in addition to its clinical benefits [ 8 , 9 ]. TasP is one of the most effective strategies to prevent HIV transmission [ 10 ], and high uptake of ART may be an effective approach to reduce HIV incidence at the population level [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and “Undetectable = Untransmittable”: A Systematic Review

et al. 2021

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People on HIV treatment with undetectable virus cannot transmit HIV sexually (Undetectable = Untransmittable, U = U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U = U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression.Review was pre-registered at PROSPERO: CRD42020153725

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“…Despite noticeable reductions in HIV infections and increases in ARVs accessibility, there are several biological, behavioural and social factors that contribute to higher HIV prevalence rates in women ( Ramjee and Daniels, 2013 ; Abdool Karim et al, 2020 ). Socio-economic factors that drive high HIV incidence rates in women include sexual abuse, lack of education, lack of food security and the lack of proper social services such as education on HIV and insufficient provision of health services; especially in highly affected regions ( Abdool Karim et al, 2012 ; Ramjee and Daniels, 2013 ; Nicol et al, 2018 ; Durevall et al, 2019 ).…”

Section: Biological Behavioural and Socio-economic Factors That Incre...mentioning

confidence: 99%

Pharmacogenomics of drug transporters for antiretroviral long-acting pre-exposure prophylaxis for HIV

et al. 2022

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The use of antiretrovirals (ARVs) as oral, topical, or long-acting pre-exposure prophylaxis (PrEP) has emerged as a promising strategy for HIV prevention. Clinical trials testing Truvada® [tenofovir disoproxil fumarate (TDF)/tenofovir (TFV) and emtricitabine (FTC)] as oral or topical PrEP in African women showed mixed results in preventing HIV infections. Since oral and topical PrEP effectiveness is dependent on adequate drug delivery and availability to sites of HIV infection such as the blood and female genital tract (FGT); host biological factors such as drug transporters have been implicated as key regulators of PrEP. Drug transporter expression levels and function have been identified as critical determinants of PrEP efficacy by regulating PrEP pharmacokinetics across various cells and tissues of the blood, renal tissues, FGT mucosal tissues and other immune cells targeted by HIV. In addition, biological factors such as genetic polymorphisms and genital inflammation also influence drug transporter expression levels and functionality. In this review, drug transporters and biological factors modulating drug transporter disposition are used to explain discrepancies observed in PrEP clinical trials. This review also provides insight at a pharmacological level of how these factors further increase the susceptibility of the FGT to HIV infections, subsequently contributing to ineffective PrEP interventions in African women.

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Putting women in the centre of the global HIV response is key to achieving epidemic control!

Cited by 9 publications

References 20 publications

Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies

Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies

Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and “Undetectable = Untransmittable”: A Systematic Review

Pharmacogenomics of drug transporters for antiretroviral long-acting pre-exposure prophylaxis for HIV

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