Declines in HIV incidence among men and women in a South African population-based cohort

AbstractOver the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.

Download Full-text

HIV incidence trends vary between jurisdictions in Australia: an extended back-projection analysis of men who have sex with men

Sexual Health ◽

10.1071/sh10141 ◽

2012 ◽

Vol 9 (2) ◽

pp. 138 ◽

Cited By ~ 13

Author(s):

Kylie-Ann Mallitt ◽

David P. Wilson ◽

Ann McDonald ◽

Handan Wand

Keyword(s):

South Australia ◽

Hiv Infections ◽

Surveillance Data ◽

Hiv Incidence ◽

Back Projection ◽

Hiv Diagnosis ◽

Incidence Trends ◽

The Past ◽

Sex With Men ◽

Incident Cases

Background Trends in HIV diagnoses differ across Australia and are primarily driven by men who have sex with men (MSM). We use national population surveillance data to estimate the incidence of HIV infections among MSM by jurisdiction and infer the proportion of undiagnosed infections. Methods: Annual surveillance data for AIDS diagnoses, HIV diagnoses and recently acquired HIV infections were obtained from 1980 to 2009. A modified statistical back-projection method was used to reconstruct HIV incidence by jurisdiction. Results: HIV incidence among MSM peaked for all jurisdictions in the early 1980s and then declined into the early 1990s, after which incidence increased. Trends then differ between jurisdictions. In New South Wales (NSW) and South Australia, estimated HIV incidence peaked at 371 and 50 cases respectively in 2003, and has since decreased to 258 and 24 cases respectively in 2009. HIV infections in Queensland (Qld) have more than doubled over the past decade, from 84 cases in 2000 to 192 cases in 2009. Victoria and Western Australia have seen a rise in HIV incidence from 2000 to 2006 (to a peak of 250 and 38 incident cases respectively), followed by a plateau to 2009. HIV incidence in the Northern Territory, Tasmania and Australian Capital Territory have increased since 2000; however, case numbers remain small (<20 per year). The estimated proportion of HIV infections not yet diagnosed to 2009 ranges from 10% (NSW) to 18% (Qld), with an average of 12% across Australia. Conclusions: HIV diagnosis trends among MSM in Australia reflect changes in estimated incidence to 2009, and reveal the largest increase in the past 10 years in Qld.

Download Full-text

Modelling the Impact of Prevention and Treatment Interventions on HIV and Hepatitis C Virus Transmission Among People Who Inject Drugs in Kenya

10.1101/2021.02.02.21251008 ◽

2021 ◽

Author(s):

Jack Stone ◽

Hannah Fraser ◽

Josephine G Walker ◽

Nyashadzaishe Mafirakureva ◽

Bernard Mundia ◽

...

Keyword(s):

Sexual Risk ◽

People Who Inject Drugs ◽

Scale Up ◽

Coastal Region ◽

Hiv Infections ◽

Hiv Incidence ◽

Hcv Treatment ◽

Opioid Substitution Therapy ◽

Substantial Impact ◽

The Impact

AbstractBackgroundPeople who inject drugs (PWID) in Kenya have a high prevalence of HIV (14-26%) and HCV (11-36%). Needle and syringe programmes (NSP) and antiretroviral therapy (ART) have high coverage among PWID, while HCV treatment and opioid substitution therapy (OST) access is low.MethodsA dynamic model of HIV (sexual and injecting-related) and HCV (injecting-related) transmission among PWID was calibrated using Bayesian methods to data from Nairobi and the Coastal region. We projected the impact of existing coverage levels of interventions (ART: 64-66%; OST: 4-7%; NSP: 54-56%) in each setting, and the impact over 2020-2030 of increasing the coverage of OST (50%) and NSP (75%; ‘full HR’), ART (UNAIDS 90-90-90 target), HCV treatment (1000 over 5 years), and reducing HIV sexual risk by 75%. We estimated HCV treatment levels needed to reduce HCV incidence by 90% with or without full HR.FindingsSince 2013, HR has averted 15.1-20.6% (range in medians across settings) of HIV infections and 29.0-31.6% of HCV infections across Nairobi and the Coastal region, with most impact being due to NSP. Conversely, ART has only averted <5% of HIV infections since 2004 because of sub-optimal viral suppression (28-48%). Going forward, Full HR and ART could reduce HIV incidence by 58.2-62.0% and HCV incidence by 62.6-81.6% by 2030 across these settings. If sexual risk is also reduced, HIV incidence would reduce by 77.1-81.4%. Alongside full HR, treating 896 PWID over 2020-2025 could reduce HCV incidence by 90% by 2030.InterpretationExisting interventions have had moderate impact on HIV and HCV transmission in Kenya, but may have substantial impact if scaled-up. However, to achieve HIV and HCV elimination, reductions in sexual risk are needed and a scale-up in HCV treatment.FundingGlobal Fund, MDM

Download Full-text

High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-209713 ◽

2017 ◽

Vol 72 (2) ◽

pp. 168-172 ◽

Cited By ~ 12

Author(s):

Alain Vandormael ◽

Tulio de Oliveira ◽

Frank Tanser ◽

Till Bärnighausen ◽

Joshua T Herbeck

Keyword(s):

Hiv Testing ◽

South African ◽

Hiv Infections ◽

Population Based ◽

Hiv Positive ◽

Aids Epidemic ◽

Undiagnosed Hiv ◽

African Community ◽

Repeat Hiv Testing ◽

High Level

BackgroundUndiagnosed HIV infections could undermine efforts to reverse the global AIDS epidemic by 2030. In this study, we estimated the percentage of HIV-positive persons who remain undiagnosed within a hyperendemic South African community.MethodsThe data come from a population-based surveillance system located in the Umkhanyakude district of the northern KwaZulu-Natal province, South Africa. We annually tested 38 661 adults for HIV between 2005 and 2016. Using the HIV-positive test results of 12 039 (31%) participants, we then back-calculated the incidence of infection and derived the number of undiagnosed cases from this result.ResultsThe percentage of undiagnosed HIV cases decreased from 29.3% in 2005 to 15.8% in 2011. During this period, however, approximately 50% of the participants refused to test for HIV, which lengthened the average time from infection to diagnosis. Consequently, the percentage of undiagnosed HIV cases reversed direction and steadily increased from 16.1% to 18.9% over the 2012–2016 period.ConclusionsResults from this hyperendemic South African setting show that the HIV testing rate is low, with long infection times, and an unsatisfactorily high percentage of undiagnosed cases. A high level of repeat HIV testing is needed to minimise the time from infection to diagnosis if the global AIDS epidemic is to be reversed within the next two decades.

Download Full-text

Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

Gut ◽

10.1136/gutjnl-2019-320007 ◽

2020 ◽

Vol 69 (12) ◽

pp. 2223-2231 ◽

Cited By ~ 1

Author(s):

Sharon J Hutchinson ◽

Heather Valerio ◽

Scott A McDonald ◽

Alan Yeung ◽

Kevin Pollock ◽

...

Keyword(s):

Antiviral Treatment ◽

Scale Up ◽

Sustained Viral Response ◽

Population Based ◽

Decompensated Cirrhosis ◽

Direct Acting Antiviral ◽

Clinical Databases ◽

Number Of Patients ◽

Direct Acting ◽

The Impact

ObjectivePopulation-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.DesignThrough analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.ResultsApproximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.ConclusionsNational scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

Download Full-text

Vulvar cancer in Germany: Increase of incidence and change of tumor-biological characteristics in the period 1974-2013.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17031 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17031-e17031

Author(s):

Jana Barinoff ◽

Jalid Sehouli ◽

Bernd Holleczek

Keyword(s):

Squamous Cell ◽

Vulvar Cancer ◽

Advanced Disease ◽

Population Level ◽

Population Based ◽

Tumor Characteristics ◽

Incidence Data ◽

Incidence Trends ◽

The Past ◽

Icd 10

e17031 Background: Incidence of vulvar cancer in Germany is increasing. Gynecological oncologists reported to observe increasing numbers of women presenting with small tumors. The aim of the presented study is to validate this observation on a population level and to extend available incidence data. Methods: Data from the population-based Saarland Cancer Registry (CR) were used and included 1,136 female patients diagnosed with invasive vulvar cancer (ICD-10 code: C51) between 1974 and 2013. Multiple imputation methodology was used to overcome loss of precision and potential bias. Incidence trends were investigated with regard to patient and tumor characteristics. Results: During the study period, the age standardized rate of incidence increased from 1.6 to 7.9 cases per 100,000 women per year (+390%). Since 1989, the incidence of squamous cell carcinoma increased from 1.7 to 7.1 (+320%), whereas no increase was observed in other morphologic types. Simultaneously, the incidence of small vulvar tumors <= 2 cm (T1) increased from 0.8 in 1989-93 to 6.6 in 2009-13 (the proportion of T1 tumors increased from 34% to 79%, respectively). Patients aged >= 75 years suffered from more advanced disease at the time of diagnosis. Conclusions: The detailed analyses revealed that the observed increase in vulvar cancer in the past 15 years mainly resulted from newly incident squamous cell carcinomas. Furthermore, the analyses showed an almost exclusive increase of T1 tumors. An increase in vulvar cancer incidence as shown for Germany could not be observed for any other European country.

Download Full-text

The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

Gates Open Research ◽

10.12688/gatesopenres.13220.1 ◽

2021 ◽

Vol 5 ◽

pp. 15

Author(s):

Eline L. Korenromp ◽

Anna Bershteyn ◽

Edina Mudimu ◽

Renay Weiner ◽

Collen Bonecwe ◽

...

Keyword(s):

South Africa ◽

Male Circumcision ◽

Hiv Transmission ◽

Scale Up ◽

Household Survey ◽

Hiv Infections ◽

Treatment Needs ◽

Medical Male Circumcision ◽

Hiv Epidemic ◽

The Impact

Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.

Download Full-text

Legal Certainty and Fundamental Rights

10.5771/9783748906063 ◽

2020 ◽

Keyword(s):

South African ◽

Fundamental Rights ◽

Current Interest ◽

High Current ◽

Legal Certainty ◽

Legal Research ◽

The Past ◽

Legal Questions ◽

The University ◽

The Impact

This book, containing legal research on the impact of legal certainty and fundamental rights on different branches of the law from a South African and German perspective, is the culmination of a collaboration between the University of Augsburg and the University of Johannesburg over the past decade. Topics of high current interest are introduced by South African scholars and responded to by their German counterparts, leading to a deeper understanding of open legal questions in both legal systems.

Download Full-text

The influence of Calvinism on the South African Council of Churches

In die Skriflig/In Luce Verbi ◽

10.4102/ids.v44i0.196 ◽

2010 ◽

Vol 44 (0) ◽

Author(s):

P.G.J. Meiring

Keyword(s):

South African ◽

The South ◽

South African Council ◽

The Past ◽

The Future ◽

History Of ◽

The Government ◽

The Impact ◽

Prophetic Witness

The impact of Calvinist theology and of reformed leadership on the South African Council of Churches (SACC) is vast. After a brief history of the SACC, the author notes the contribution that a number of reformed and presbyterian clergy and theologians have made – as presidents, general secretaries or as theo- logians who helped develop the SACC’s message. At least five principles that Calvin held dear, are reflected in the SACC’s agenda during the past decades: the quest for unity, the con- cern for mission, covenanting for justice, providing a prophetic witness in the community, and when the need arose, the willingness to confront the government of the day. The article concludes with a brief look at the future of the SACC and of the continued input that reformed theologians may be able to make.

Download Full-text

The Impact of Medicare's Alternative Payment Models on the Value of Care

Annual Review of Public Health ◽

10.1146/annurev-publhealth-040119-094327 ◽

2020 ◽

Vol 41 (1) ◽

pp. 551-565

Author(s):

Joshua M. Liao ◽

Amol S. Navathe ◽

Rachel M. Werner

Keyword(s):

Health Care ◽

Health Care System ◽

National Health ◽

Population Based ◽

Unintended Consequences ◽

National Health Care ◽

The Past ◽

The Impact ◽

Payment Models ◽

Medicare Spending

Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.

Download Full-text

Cohort profile: l’Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada

BMJ Open ◽

10.1136/bmjopen-2018-028768 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028768 ◽

Cited By ~ 6

Author(s):

Zoë R Greenwald ◽

Mathieu Maheu-Giroux ◽

Jason Szabo ◽

Judith Alexia B Robin ◽

Michel Boissonnault ◽

...

Keyword(s):

Population Level ◽

Hiv Infections ◽

Health Clinic ◽

Moderate Increase ◽

Hiv Incidence ◽

Sexually Transmitted ◽

Before And After ◽

Exposure Prophylaxis ◽

The Impact

PurposeThel’Actuel PrEP Cohortwas established to monitor the uptake, effectiveness, safety and changes in sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique médicale l’Actuel, a large sexual health clinic located in Montreal, Canada.ParticipantsSince the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l’Actuel PrEP Cohort. Median age was 35 years (IQR: 29–44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7–19.6), with substantial variation based on year of cohort entry. Thel’Actuel PrEP Cohortcontains both daily and intermittent ‘on-demand’ PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America.Findings to dateNo incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in sexually transmitted infections was observed following PrEP start.Future plansThel’Actuel PrEP Cohortcontinues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.

Download Full-text