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Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa.
Akullian, Adam; Vandormael, Alain; Miller, Joel C; Bershteyn, Anna; Wenger, Edward; Cuadros, Diego; Gareta, Dickman; Bärnighausen, Till; Herbst, Kobus; Tanser, Frank.
Afiliação
  • Akullian A; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA 98109; aakullian@idmod.org.
  • Vandormael A; Department of Global Health, University of Washington, Seattle, WA, 98195.
  • Miller JC; Heidelberg Institute for Global Health, Heidelberg University, 69120 Heidelberg, Germany.
  • Bershteyn A; KwaZulu-Natal Research and Innovation Sequencing Platform, University of KwaZulu-Natal, Durban 4001, South Africa.
  • Wenger E; School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, VIC 3086, Australia.
  • Cuadros D; Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016.
  • Gareta D; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA 98109.
  • Bärnighausen T; Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH 45221.
  • Herbst K; Africa Health Research Institute, KwaZulu-Natal 4001, South Africa.
  • Tanser F; Heidelberg Institute for Global Health, Heidelberg University, 69120 Heidelberg, Germany.
Proc Natl Acad Sci U S A ; 118(28)2021 07 13.
Article em En | MEDLINE | ID: mdl-34244424
ABSTRACT
Recent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist to support these projections. We conducted a population-based cohort study over a 16-y period (2004 to 2019), spanning the early scale-up of antiretroviral therapy and voluntary medical male circumcision, to estimate changes in the age distribution of HIV incidence in a hyperepidemic region of KwaZulu-Natal, South Africa, where adult HIV incidence has recently declined. Median age of HIV seroconversion increased by 5.5 y in men and 3.0 y in women, and the age of peak HIV incidence increased by 5.0 y in men and 2.0 y in women. Incidence declined disproportionately among young men (64% in men 15 to 19, 68% in men 20 to 24, and 46% in men 25 to 29) and young women (44% in women 15 to 19, 24% in women 20 to 24) comparing periods pre- versus post-universal test and treat. Incidence was stable (<20% change) in women aged 30 to 39 and men aged 30 to 34. Age shifts in incidence occurred after 2012 and were observed earlier in men than in women. These results provide direct epidemiological evidence of the changing demographics of HIV risk in sub-Saharan Africa in the era of large-scale treatment and prevention. More attention is needed to address lagging incidence decline among older individuals.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / HIV-1 Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País como assunto: Africa Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / HIV-1 Tipo de estudo: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Female / Humans / Male / Middle aged País como assunto: Africa Idioma: En Ano de publicação: 2021 Tipo de documento: Article