ArticleInternational journal of epidemiology2020
The state of the HIV epidemic in rural KwaZulu-Natal, South Africa: a novel application of disease metrics to assess trajectories and highlight areas for intervention.
Article in International journal of epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed.
- Cost-Effectiveness of Reducing HIV Infections Through Screening and Treating Alcohol Use and Depression in KwaZulu-Natal, South Africa: A Mathematical Modeling Study.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Streamlining Stigma Measurement: Validation and Abridgment of the HIV Stigma Scale for Pregnant Women Living with HIV in South Africa.AIDS and behavior · 2026Article
- HIV-related stressors and psychological functioning among adolescents living with perinatal HIV in KwaZulu-Natal, South Africa.Frontiers in public health · 2025Article
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- Cytokine Gene Expression Profiles during HIV and Helminth Coinfection in Underprivileged Peri-Urban South African Adults.Diagnostics (Basel, Switzerland) · 2023Article
- Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90-90-90 targets among younger men in Rwanda.Journal of medical virology · 2023Article
- Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa.African journal of laboratory medicine · 2023Article
- Geo-analysis: the distribution of community health workers in relation to the HIV prevalence in KwaZulu-Natal province, South Africa.BMC health services research · 2022Article
- Mortality in HIV and tuberculosis patients following implementation of integrated HIV-TB treatment: Results from an open-label cluster-randomized trial.EClinicalMedicine · 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
- Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks.PloS one · 2022Article
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- The role of high-risk geographies in the perpetuation of the HIV epidemic in rural South Africa: A spatial molecular epidemiology study.PLOS global public health · 2022Article
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- The development of an explanatory model for voluntary medical male circumcision in KwaZulu-Natal, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2021Article
- Beyond HIV prevalence: identifying people living with HIV within underserved areas in South Africa.BMJ global health · 2021Article
- World AIDS Day 2020: Reflections on global and South African progress and continuing challenges.Southern African journal of HIV medicine · 2021Article
- BMI and All-Cause Mortality in a Population-Based Cohort in Rural South Africa.Obesity (Silver Spring, Md.) · 2020Article
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5 authors.
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Abstract
backgroundSouth Africa is at the epicentre of the HIV pandemic, with the world's highest number of new infections and the largest treatment programme. Using metrics proposed by the Joint United Nations Programme on AIDS (UNAIDS), we evaluate progress toward epidemic control and highlight areas for intervention in a hyperendemic South African setting.
methodsThe Africa Health Research Institute (AHRI) maintains a comprehensive population-based surveillance system in the Hlabisa sub-district of KwaZulu-Natal. Between 2005 and 2017, we tested 39 735 participants (aged 15-49 years) for HIV and followed 22 758 HIV-negative and 13 460 HIV-positive participants to identify new infections and all-cause AIDS-related deaths, respectively. Using these data, we estimated the percentage reduction in incidence, the absolute incidence rate, the incidence-mortality ratio and the incidence-prevalence ratio over place and time.
resultsWe observed a 62% reduction in the number of new infections among men between 2012 and 2017 and a 34% reduction among women between 2014 and 2017. Among men, the incidence-mortality ratio peaked at 4.1 in 2013 and declined to 3.1 in 2017, and among women it fell from a high of 6.4 in 2014 to 4.3 in 2017. Between 2012 and 2017, the female-incidence/male-prevalence ratio declined from 0.24 to 0.13 and the male-incidence/female-prevalence ratio from 0.05 to 0.02.
conclusionsUsing data from a population-based cohort study, we report impressive progress toward HIV epidemic control in a severely affected South African setting. However, overall progress is off track for 2020 targets set by the UNAIDS. Spatial estimates of the metrics, which demonstrate remarkable heterogeneity over place and time, indicate areas that could benefit from additional or optimized HIV prevention services.
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