Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern
Despite over two decades of progress against HIV/AIDS in adjacent sub-Saharan Africa, HIV rates and deaths due to AIDS are exponentially rising in Madagascar. Furthermore, a growing body of evidence suggests that, due to a scarcity of general-population screening data, even the startling increase de...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Tropical Medicine and Infectious Disease |
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| Online Access: | https://www.mdpi.com/2414-6366/9/1/19 |
| _version_ | 1827371113986916352 |
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| author | Kyle E. Robinson Jackson K. Long Mamantsara Fardine Adriantiana M. Stephano Andrew Walsh Eric P. Grewal |
| author_facet | Kyle E. Robinson Jackson K. Long Mamantsara Fardine Adriantiana M. Stephano Andrew Walsh Eric P. Grewal |
| author_sort | Kyle E. Robinson |
| collection | DOAJ |
| description | Despite over two decades of progress against HIV/AIDS in adjacent sub-Saharan Africa, HIV rates and deaths due to AIDS are exponentially rising in Madagascar. Furthermore, a growing body of evidence suggests that, due to a scarcity of general-population screening data, even the startling increase demonstrated by official models vastly underestimates the true population prevalence of HIV. We aimed to implement a real-world HIV screening and treatment protocol to serve a general population stemming from across northern Madagascar. In collaboration with the Malagasy Ministry of Health, we provided point-of-care HIV screening and confirmatory testing for over 1000 participants from 73 towns, villages, and cities. We recorded an overall HIV prevalence of 2.94%. Notably, we observed a 13.1% HIV prevalence rate among urban populations and showed that proximity to a major route of travel was significantly associated with HIV risk. We also observed a link between HIV risk and various occupations, including those associated with increased mobility (such as mining). Importantly, all HIV-positive individuals were initiated on antiretroviral therapy in concordance with local health authorities. To our knowledge, this study marks the largest primary test data-based HIV study to date among Madagascar’s general population, showing a greatly higher HIV prevalence (2.9%) than previously reported modeling-based figures (0.4%). Our rates aligned with the pattern of higher prevalence demonstrated in smaller general-population screening studies occurring more commonly prior to political strife in the mid-2000s. These findings demonstrate evidence of a growing HIV epidemic in northern Madagascar and underscore the need for future investment into more comprehensive HIV screening and control initiatives in Madagascar. |
| first_indexed | 2024-03-08T10:33:30Z |
| format | Article |
| id | doaj.art-7b5d3cffe3c34206851fc3c69de30697 |
| institution | Directory Open Access Journal |
| issn | 2414-6366 |
| language | English |
| last_indexed | 2024-03-08T10:33:30Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Tropical Medicine and Infectious Disease |
| spelling | doaj.art-7b5d3cffe3c34206851fc3c69de306972024-01-26T18:42:49ZengMDPI AGTropical Medicine and Infectious Disease2414-63662024-01-01911910.3390/tropicalmed9010019Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health ConcernKyle E. Robinson0Jackson K. Long1Mamantsara Fardine2Adriantiana M. Stephano3Andrew Walsh4Eric P. Grewal5Mada Clinics, Maventibao, MadagascarMada Clinics, Maventibao, MadagascarMada Clinics, Maventibao, MadagascarMada Clinics, Maventibao, MadagascarDepartment of Anthropology, University of Western Ontario, London, ON N6A 3K7, CanadaMada Clinics, Maventibao, MadagascarDespite over two decades of progress against HIV/AIDS in adjacent sub-Saharan Africa, HIV rates and deaths due to AIDS are exponentially rising in Madagascar. Furthermore, a growing body of evidence suggests that, due to a scarcity of general-population screening data, even the startling increase demonstrated by official models vastly underestimates the true population prevalence of HIV. We aimed to implement a real-world HIV screening and treatment protocol to serve a general population stemming from across northern Madagascar. In collaboration with the Malagasy Ministry of Health, we provided point-of-care HIV screening and confirmatory testing for over 1000 participants from 73 towns, villages, and cities. We recorded an overall HIV prevalence of 2.94%. Notably, we observed a 13.1% HIV prevalence rate among urban populations and showed that proximity to a major route of travel was significantly associated with HIV risk. We also observed a link between HIV risk and various occupations, including those associated with increased mobility (such as mining). Importantly, all HIV-positive individuals were initiated on antiretroviral therapy in concordance with local health authorities. To our knowledge, this study marks the largest primary test data-based HIV study to date among Madagascar’s general population, showing a greatly higher HIV prevalence (2.9%) than previously reported modeling-based figures (0.4%). Our rates aligned with the pattern of higher prevalence demonstrated in smaller general-population screening studies occurring more commonly prior to political strife in the mid-2000s. These findings demonstrate evidence of a growing HIV epidemic in northern Madagascar and underscore the need for future investment into more comprehensive HIV screening and control initiatives in Madagascar.https://www.mdpi.com/2414-6366/9/1/19HIVprevalenceMadagascarpoint of careepidemic |
| spellingShingle | Kyle E. Robinson Jackson K. Long Mamantsara Fardine Adriantiana M. Stephano Andrew Walsh Eric P. Grewal Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern Tropical Medicine and Infectious Disease HIV prevalence Madagascar point of care epidemic |
| title | Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern |
| title_full | Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern |
| title_fullStr | Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern |
| title_full_unstemmed | Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern |
| title_short | Patterns of Rising HIV Positivity in Northern Madagascar: Evidence of an Urgent Public Health Concern |
| title_sort | patterns of rising hiv positivity in northern madagascar evidence of an urgent public health concern |
| topic | HIV prevalence Madagascar point of care epidemic |
| url | https://www.mdpi.com/2414-6366/9/1/19 |
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