ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2016
Antiretroviral Therapy to Prevent HIV Acquisition in Serodiscordant Couples in a Hyperendemic Community in Rural South Africa.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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25 citing papers in PubMed, 38 citations in OpenAlex.
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- Applying machine learning and predictive modeling to retention and viral suppression in South African HIV treatment cohorts.Scientific reports · 2022Article
- Predictors of Stigma and Health-Related Quality of Life Among People Living with HIV in Northern Thailand.AIDS patient care and STDs · 2022Article
- The geography and inter-community configuration of new sexual partnership formation in a rural South African population over fourteen years (2003-2016).PLOS global public health · 2022Article
- Psychosocial support for HIV serodiscordant couples.Health psychology and behavioral medicine · 2022Article
- HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys.PloS one · 2021Article
- The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV.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
- Article
- HIV seroconcordance among heterosexual couples in rural KwaZulu-Natal, South Africa: a population-based analysis.Journal of the International AIDS Society · 2020Article
- Declines in HIV incidence among men and women in a South African population-based cohort.Nature communications · 2019Article
- Brief Report: Intimate Partner Violence and Antiretroviral Therapy Initiation Among Female Sex Workers Newly Diagnosed With HIV in Zambia: A Prospective Study.Journal of acquired immune deficiency syndromes (1999) · 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
- High HIV-1 RNA Among Newly Diagnosed People in Botswana.AIDS research and human retroviruses · 2018Article
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10 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundAntiretroviral therapy (ART) was highly efficacious in preventing human immunodeficiency virus (HIV) transmission in stable serodiscordant couples in the HPTN-052 study, a resource-intensive randomized controlled trial with near-perfect ART adherence and mutual HIV status disclosure among all participating couples. However, minimal evidence exists of the effectiveness of ART in preventing HIV acquisition in stable serodiscordant couples in "real-life" population-based settings in hyperendemic communities of sub-Saharan Africa, where health systems are typically resource-poor and overburdened, adherence to ART is often low, and partners commonly do not disclose their HIV status to each other.
methodsData arose from a population-based open cohort in KwaZulu-Natal, South Africa. A total of 17 016 HIV-uninfected individuals present between January 2005 and December 2013 were included. Interval-censored time-updated proportional hazards regression was used to assess how the ART status affected HIV transmission risk in stable serodiscordant relationships.
resultsWe observed 1619 HIV seroconversions in 17 016 individuals, over 60 349 person-years follow-up time. During the follow-up period, 1846 individuals had an HIV-uninfected and 196 had an HIV-infected stable partner HIV incidence was 3.8/100 person-years (PY) among individuals with an HIV-infected partner (95% confidence interval [CI], 2.3-5.6), 1.4/100 PY (.4-3.5) among those with HIV-infected partners receiving ART, and 5.6/100 PY (3.5-8.4) among those with HIV-infected partners not receiving ART. Use of ART was associated with a 77% decrease in HIV acquisition risk among serodiscordant couples (adjusted hazard ratio, 0.23; 95% CI, .07-.80).
conclusionsART initiation was associated with a very large reduction in HIV acquisition in serodiscordant couples in rural KwaZulu-Natal. However, this "real-life" effect was substantially lower than the effect observed in the HPTN-052 trial. To eliminate HIV transmission in serodiscordant couples, additional prevention interventions are probably needed.
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