HIV incidence in Botswana rural communities with high antiretroviral treatment coverage: Results from the Botswana Combination Prevention Project, 2013–2017

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Ussery, Faith ; Bachanas, Pamela ; Alwano, Mary Grace ; Lebelonyane, Refeletswe ; Block, Lisa ; Wirth, Kathleen ; Ussery, Gene ; Sento, Baraedi ; Gaolathe, Tendani ; Kadima, Etienne ; Abrams, William ; Segolodi, Tebogo ; Hader, Shannon ; Lockman, Shahin ; Moore, Janet
• Description:
  Background and Setting
  
  The Botswana Combination Prevention Project (BCPP) demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. We report rates and characteristics of incident HIV infections.
  
  Methods
  
  BCPP was a community-randomized controlled trial conducted in 30 rural/peri-urban Botswana communities from 2013 to 2017. Home-based and mobile HIV-testing campaigns were conducted in 15 intervention communities, with 39% of participants testing at least twice. We assessed the HIV incidence rate (IR; number of new HIV infections per 100 person-years (py) at risk) among repeat testers and risk factors with a Cox proportional hazards regression model.
  
  Results
  
  During 27,517py, 195 (women,79%) of 18,597 became HIV-infected (0.71/100py). Women had a higher IR (1.01/100py; 95% CI, 0.99 to 1.02) than men (0.34/100py; 95% CI, 0.33 to 0.35). The highest IRs were among women aged 16–24 years (1.87/100py) and men aged 25–34 years (0.56/100py). The lowest IRs were among those aged 35–64 years (women,0.41/100py; men,0.20/100py). Hazard of incident infection was highest among women aged 16–24 (HR=7.05). Sex and age were significantly associated with incidence (both P<0.0001).
  
  Conclusions
  
  Despite an overall reduction in HIV incidence and approaching the UNAIDS 95-95-95 targets, high HIV incidence was observed in adolescent girls and young women. These findings highlight the need for additional prevention services [pre-exposure prophylaxis (PrEP), DREAMS] to achieve epidemic control in this subpopulation and increased efforts with men with undiagnosed HIV.
  
  
• Keywords:
  Adolescent Anti-Retroviral Agents Botswana Combination Prevention Female HIV Incidence HIV Infections Humans Incidence Male Rural Population Young Women

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• Source:
  J Acquir Immune Defic Syndr. 91(1):9-16
• Pubmed ID:
  35537094
• Pubmed Central ID:
  PMC9388617
• Document Type:
  Journal Article
• Funding:
  U2G GH000419/GH/CGH CDC HHSUnited States/ ; U2GGH001911/ACL/ACL HHSUnited States/ ; U01 GH000447/GH/CGH CDC HHSUnited States/ ; U2G GH000073/GH/CGH CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/ ; U2G GH001911/GH/CGH CDC HHSUnited States/
• Volume:
  91
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:1f2820e9e9d6de9a0c6fdbd6527e9acd588ddb326d89cb68bb9fa16a2c9cd5fd
• Download URL:
  https://stacks.cdc.gov/view/cdc/120440/cdc_120440_DS1.pdf
• File Type:
  [PDF - 411.48 KB ]