The University of Southampton
University of Southampton Institutional Repository

Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004-2012: a prospective cohort study

Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004-2012: a prospective cohort study
Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004-2012: a prospective cohort study
Background: studies 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.

Methods: in 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.

Findings: 2037 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).

Interpretation: our 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
2214-109X
e209-e215
Vandormael, A.
5072f8df-3cab-4e6a-b58a-b725a579303f
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Barnighausen, T.
f849cc9c-3d71-4ef2-a722-200cac903716
Tanser, F.
b4ce79a2-0bf2-4021-89ad-0e759e2e2fc8
Vandormael, A.
5072f8df-3cab-4e6a-b58a-b725a579303f
Newell, M.L.
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Barnighausen, T.
f849cc9c-3d71-4ef2-a722-200cac903716
Tanser, F.
b4ce79a2-0bf2-4021-89ad-0e759e2e2fc8

Vandormael, A., Newell, M.L., Barnighausen, T. and Tanser, F. (2014) Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004-2012: a prospective cohort study. The Lancet Global Health, 2 (4), e209-e215. (doi:10.1016/S2214-109X(14)70018-X).

Record type: Article

Abstract

Background: studies 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.

Methods: in 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.

Findings: 2037 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).

Interpretation: our 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

Text
van Dormael et al ART in the household Lancet Global Health 2014.pdf - Version of Record
Available under License Creative Commons Attribution.
Download (94kB)

More information

Published date: April 2014
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 379598
URI: http://eprints.soton.ac.uk/id/eprint/379598
ISSN: 2214-109X
PURE UUID: a2862384-054b-4a3b-9a91-63cb846bc030
ORCID for M.L. Newell: ORCID iD orcid.org/0000-0002-1074-7699

Catalogue record

Date deposited: 06 Aug 2015 08:03
Last modified: 17 Dec 2019 01:36

Export record

Altmetrics

Contributors

Author: A. Vandormael
Author: M.L. Newell ORCID iD
Author: T. Barnighausen
Author: F. Tanser

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×