High HIV incidence among young women in South Africa: Data from a large prospective study.
<h4>Introduction</h4>South Africa has the highest national burden of HIV globally. Understanding drivers of HIV acquisition in recently completed, prospective studies in which HIV was an endpoint may help inform the strategy and investments in national HIV prevention efforts and guide th...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0269317 |
| _version_ | 1818191454626906112 |
|---|---|
| author | Thesla Palanee-Phillips Helen V Rees Kate B Heller Khatija Ahmed Joanne Batting Ivana Beesham Renee Heffron Jessica Justman Heeran Makkan Timothy D Mastro Susan A Morrison Nelly Mugo Gonasagrie Nair James Kiarie Neena M Philip Melanie Pleaner Krishnaveni Reddy Pearl Selepe Petrus S Steyn Caitlin W Scoville Jenni Smit Katherine K Thomas Deborah Donnell Jared M Baeten ECHO Trial Consortium |
| author_facet | Thesla Palanee-Phillips Helen V Rees Kate B Heller Khatija Ahmed Joanne Batting Ivana Beesham Renee Heffron Jessica Justman Heeran Makkan Timothy D Mastro Susan A Morrison Nelly Mugo Gonasagrie Nair James Kiarie Neena M Philip Melanie Pleaner Krishnaveni Reddy Pearl Selepe Petrus S Steyn Caitlin W Scoville Jenni Smit Katherine K Thomas Deborah Donnell Jared M Baeten ECHO Trial Consortium |
| author_sort | Thesla Palanee-Phillips |
| collection | DOAJ |
| description | <h4>Introduction</h4>South Africa has the highest national burden of HIV globally. Understanding drivers of HIV acquisition in recently completed, prospective studies in which HIV was an endpoint may help inform the strategy and investments in national HIV prevention efforts and guide the design of future HIV prevention trials. We assessed HIV incidence and correlates of incidence among women enrolled in ECHO (Evidence for Contraceptive Options and HIV Outcomes), a large, open-label randomized clinical trial that compared three highly effective. reversible methods of contraception and rates of HIV acquisition.<h4>Methods</h4>During December 2015 to October 2018, ECHO followed sexually active, HIV-seronegative women, aged 16-35 years, seeking contraceptive services and willing to be randomized to one of three contraceptive methods (intramuscular depot medroxyprogesterone acetate, copper intrauterine device, or levonorgestrel implant) for 12-18 months at nine sites in South Africa. HIV incidence based on prospectively observed HIV seroconversion events. Cox proportional hazards regression models were used to define baseline cofactors related to incident HIV infection.<h4>Results</h4>5768 women were enrolled and contributed 7647 woman-years of follow-up. The median age was 23 years and 62.5% were ≤24 years. A total of 345 incident HIV infections occurred, an incidence of 4.51 per 100 woman-years (95%CI 4.05-5.01). Incidence was >3 per 100 woman-years at all sites. Age ≤24 years, baseline infection with sexually transmitted infections, BMI≤30, and having new or multiple partners in the three months prior to enrollment were associated with incident HIV.<h4>Conclusions</h4>HIV incidence was high among South African women seeking contraceptive services. Integration of diagnostic management of sexually transmitted infections alongside delivery of HIV prevention options in health facilities providing contraception services are needed to mitigate ongoing risks of HIV acquisition for this vulnerable population.<h4>Clinical trial registration</h4>ClinicalTrials.gov, number NCT02550067 was the main Clinical Trial from which this secondary, non-randomized / observational analysis was derived with data limited to just South African sites. |
| first_indexed | 2024-12-12T00:14:52Z |
| format | Article |
| id | doaj.art-6d7a8d15a7d7447b86a994117dd051df |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T00:14:52Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-6d7a8d15a7d7447b86a994117dd051df2022-12-22T00:44:52ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01176e026931710.1371/journal.pone.0269317High HIV incidence among young women in South Africa: Data from a large prospective study.Thesla Palanee-PhillipsHelen V ReesKate B HellerKhatija AhmedJoanne BattingIvana BeeshamRenee HeffronJessica JustmanHeeran MakkanTimothy D MastroSusan A MorrisonNelly MugoGonasagrie NairJames KiarieNeena M PhilipMelanie PleanerKrishnaveni ReddyPearl SelepePetrus S SteynCaitlin W ScovilleJenni SmitKatherine K ThomasDeborah DonnellJared M BaetenECHO Trial Consortium<h4>Introduction</h4>South Africa has the highest national burden of HIV globally. Understanding drivers of HIV acquisition in recently completed, prospective studies in which HIV was an endpoint may help inform the strategy and investments in national HIV prevention efforts and guide the design of future HIV prevention trials. We assessed HIV incidence and correlates of incidence among women enrolled in ECHO (Evidence for Contraceptive Options and HIV Outcomes), a large, open-label randomized clinical trial that compared three highly effective. reversible methods of contraception and rates of HIV acquisition.<h4>Methods</h4>During December 2015 to October 2018, ECHO followed sexually active, HIV-seronegative women, aged 16-35 years, seeking contraceptive services and willing to be randomized to one of three contraceptive methods (intramuscular depot medroxyprogesterone acetate, copper intrauterine device, or levonorgestrel implant) for 12-18 months at nine sites in South Africa. HIV incidence based on prospectively observed HIV seroconversion events. Cox proportional hazards regression models were used to define baseline cofactors related to incident HIV infection.<h4>Results</h4>5768 women were enrolled and contributed 7647 woman-years of follow-up. The median age was 23 years and 62.5% were ≤24 years. A total of 345 incident HIV infections occurred, an incidence of 4.51 per 100 woman-years (95%CI 4.05-5.01). Incidence was >3 per 100 woman-years at all sites. Age ≤24 years, baseline infection with sexually transmitted infections, BMI≤30, and having new or multiple partners in the three months prior to enrollment were associated with incident HIV.<h4>Conclusions</h4>HIV incidence was high among South African women seeking contraceptive services. Integration of diagnostic management of sexually transmitted infections alongside delivery of HIV prevention options in health facilities providing contraception services are needed to mitigate ongoing risks of HIV acquisition for this vulnerable population.<h4>Clinical trial registration</h4>ClinicalTrials.gov, number NCT02550067 was the main Clinical Trial from which this secondary, non-randomized / observational analysis was derived with data limited to just South African sites.https://doi.org/10.1371/journal.pone.0269317 |
| spellingShingle | Thesla Palanee-Phillips Helen V Rees Kate B Heller Khatija Ahmed Joanne Batting Ivana Beesham Renee Heffron Jessica Justman Heeran Makkan Timothy D Mastro Susan A Morrison Nelly Mugo Gonasagrie Nair James Kiarie Neena M Philip Melanie Pleaner Krishnaveni Reddy Pearl Selepe Petrus S Steyn Caitlin W Scoville Jenni Smit Katherine K Thomas Deborah Donnell Jared M Baeten ECHO Trial Consortium High HIV incidence among young women in South Africa: Data from a large prospective study. PLoS ONE |
| title | High HIV incidence among young women in South Africa: Data from a large prospective study. |
| title_full | High HIV incidence among young women in South Africa: Data from a large prospective study. |
| title_fullStr | High HIV incidence among young women in South Africa: Data from a large prospective study. |
| title_full_unstemmed | High HIV incidence among young women in South Africa: Data from a large prospective study. |
| title_short | High HIV incidence among young women in South Africa: Data from a large prospective study. |
| title_sort | high hiv incidence among young women in south africa data from a large prospective study |
| url | https://doi.org/10.1371/journal.pone.0269317 |
| work_keys_str_mv | AT theslapalaneephillips highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT helenvrees highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT katebheller highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT khatijaahmed highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT joannebatting highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT ivanabeesham highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT reneeheffron highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT jessicajustman highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT heeranmakkan highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT timothydmastro highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT susanamorrison highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT nellymugo highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT gonasagrienair highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT jameskiarie highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT neenamphilip highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT melaniepleaner highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT krishnavenireddy highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT pearlselepe highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT petrusssteyn highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT caitlinwscoville highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT jennismit highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT katherinekthomas highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT deborahdonnell highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT jaredmbaeten highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy AT echotrialconsortium highhivincidenceamongyoungwomeninsouthafricadatafromalargeprospectivestudy |