Trends in HIV prevalence in pregnant women in rural South Africa
Published Date:Nov 1 2015
Source:J Acquir Immune Defic Syndr. 70(3):289-295.
Pubmed Central ID:PMC5056320
Funding:D43TW00231/TW/FIC NIH HHS/United States
5U2GPS001350/PHS HHS/United States
D43 TW000231/TW/FIC NIH HHS/United States
U19 AI051794/AI/NIAID NIH HHS/United States
U2G PS001350/PS/NCHHSTP CDC HHS/United States
1U19 AI51794/AI/NIAID NIH HHS/United States
Despite substantial progress in the delivery of HIV prevention programs, some communities continue to experience high rates of HIV infection. We report on temporal trends in HIV prevalence in pregnant women in a community in rural KwaZulu-Natal (KZN) in South Africa.
Annual, anonymous cross-sectional HIV sero-prevalence surveys were conducted between 2001 and 2013 amongst first visit prenatal clinic attendees. The time periods 2001 to 2003 were defined as pre-antiretroviral therapy (ART), 2004 to 2008 as early ART and 2009 to 2013 as contemporary ART roll-out to correspond with the substantial scale-up of ART program.
Overall, HIV prevalence rose from 35.3% [95% confidence interval (CI) 32.3–38.3] pre-ART (2001–2003) to 39.0% (CI: 36.8–41.1) in the early ART (2004–2008) to 39.3% (CI: 37.2–41.4) in the contemporary ART (2009–2013) roll-out periods. In teenage women (<20 years), HIV prevalence declined from 22.5% (CI: 17.5–27.5) to 20.7% (CI: 17.5–23.8) and to 17.2% (CI: 14.3–20.2) over the similar ART roll-out periods (p=0.046). Prevalence increased significantly in women 30 years and older (p<0.001) over the same time period largely due to survival following ART scale up. Teenage girls with male partners 20–24 and ≥25 years had a 1.7-fold (CI: 1.3–2.4; p=0.001) and 3-fold (CI: 2.1–4.3; p<0.001) higher HIV prevalence respectively.
Notwithstanding the encouraging decline in teenagers, the ongoing high HIV prevalence in pregnant women in this rural community, despite prevention and treatment programs, is deeply concerning. Targeted interventions for teenagers, especially for those in age-disparate relationships, are needed to impact this HIV epidemic trajectory.
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