ArticleThe Lancet. Global health2014
Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004–12: a prospective cohort study.
Article in The Lancet. Global health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it, 56 citations in OpenAlex.
- Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis.The Lancet. Global health · 2019Pooled it
- Infant feeding knowledge and practice vary by maternal HIV status: a nested cohort study in rural South Africa.International breastfeeding journal · 2020Trial
- A method for statistical analysis of repeated residential movements to link human mobility and HIV acquisition.PloS one · 2019Trial
- Self-reported HIV testing and treatment among migrants from northeast South Africa: A cross-sectional, population-based analysis.Southern African journal of HIV medicine · 2025Article
- Geospatial and temporal mapping of detectable HIV-1 viral loads amid dolutegravir rollout in KwaZulu-Natal, South Africa.PLOS global public health · 2024Article
- Predictors of migration in an HIV hyper-endemic rural South African community: evidence from a population-based cohort (2005-2017).BMC public health · 2022Article
- Cohort Profile Update: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey.International journal of epidemiology · 2021Article
- ART use and associated factors among HIV positive caregivers of orphans and vulnerable children in Tanzania.BMC public health · 2020Article
- HIV incidence declines in a rural South African population: a G-imputation approach for inference.BMC public health · 2020Article
- Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort.Current HIV/AIDS reports · 2020Review
- Declines in HIV incidence among men and women in a South African population-based cohort.Nature communications · 2019Article
- Sociobehavioral and community predictors of unsuppressed HIV viral load: multilevel results from a hyperendemic rural South African population.AIDS (London, England) · 2019Article
- Effect of ART scale-up and female migration intensity on risk of HIV acquisition: results from a population-based cohort in KwaZulu-Natal, South Africa.BMC public health · 2019Observational
- A longitudinal review of national HIV policy and progress made in health facility implementation in Eastern Zimbabwe.Health research policy and systems · 2018Article
- Tracking external introductions of HIV using phylodynamics reveals a major source of infections in rural KwaZulu-Natal, South Africa.Virus evolution · 2018Article
- Longitudinal Trends in the Prevalence of Detectable HIV Viremia: Population-Based Evidence From Rural KwaZulu-Natal, South Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- Identifying 'corridors of HIV transmission' in a severely affected rural South African population: a case for a shift toward targeted prevention strategies.International journal of epidemiology · 2018Article
- Impact of early antiretroviral therapy eligibility on HIV acquisition: household-level evidence from rural South Africa.AIDS (London, England) · 2018Article
- Progress towards the UNAIDS 90-90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey.BMC public health · 2018Article
- Incidence rate estimation, periodic testing and the limitations of the mid-point imputation approach.International journal of epidemiology · 2018Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundStudies of HIV-serodiscordant couples in stable sexual relationships have provided convincing evidence that antiretroviral therapy can prevent the transmission of HIV. We aimed to quantify the preventive effect of a public-sector HIV treatment and care programme based in a community with poor knowledge and disclosure of HIV status, frequent migration, late marriage, and multiple partnerships. Specifically, we assessed whether an individual's hazard of HIV acquisition was associated with antiretroviral therapy coverage among household members of the opposite sex.
methodsIn this prospective cohort study, we linked patients' records from a public-sector HIV treatment programme in rural KwaZulu-Natal, South Africa, with population-based HIV surveillance data collected between 2004 and 2012. We used information about coresidence to construct estimates of HIV prevalence and antiretroviral therapy coverage for each household. We then regressed the time to HIV seroconversion for 14,505 individuals, who were HIV-uninfected at baseline and individually followed up over time regarding their HIV status, on opposite-sex household antiretroviral therapy coverage, controlling for household HIV prevalence and a range of other potential confounders.
findings2037 individual HIV seroconversions were recorded during 54,845 person-years of follow-up. For each increase of ten percentage points in opposite-sex household antiretroviral therapy coverage, the HIV acquisition hazard was reduced by 6% (95% CI 2–9), after controlling for other factors. This effect size translates into large reductions in HIV acquisition hazards when household antiretroviral therapy coverage is substantially increased. For example, an increase of 50 percentage points in household antiretroviral therapy coverage (eg, from 20% to 70%) reduced the hazard of HIV acquisition by 26% (95% CI 9–39).
interpretationOur findings provide further evidence that antiretroviral therapy significantly reduces the risk of onward transmission of HIV in a real-world setting in sub-Saharan Africa. Awareness that antiretroviral therapy can prevent transmission to coresident sexual partners could be a powerful motivator for HIV testing and antiretroviral treatment uptake, retention, and adherence.
fundingWellcome Trust and National Institute of Child Health and Human Development (US National Institutes of Health).
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