Abstract
BackgroundThree national HIV household surveys were conducted in South Africa, in 2002, 2005 and 2008. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use.Methods and Principal FindingsWe used a validated mathematical method to estimate the rate of new HIV infections (HIV incidence) in South Africa using nationally representative HIV prevalence data collected in 2002, 2005 and 2008. The observed HIV prevalence levels in 2008 were adjusted for the effect of antiretroviral treatment on survival. The estimated “excess” HIV prevalence due to ART in 2008 was highest among women 25 years and older and among men 30 years and older. In the period 2002–2005, the HIV incidence rate among men and women aged 15–49 years was estimated to be 2.0 new infections each year per 100 susceptible individuals (/100pyar) (uncertainty range: 1.2–3.0/100pyar). The highest incidence rate was among 15–24 year-old women, at 5.5/100pyar (4.5–6.5). In the period 2005–2008, incidence among men and women aged 15–49 was estimated to be 1.3/100 (0.6–2.5/100pyar), although the change from 2002–2005 was not statistically significant. However, the incidence rate among young women aged 15–24 declined by 60% in the same period, to 2.2/100pyar, and this change was statistically significant. There is evidence from the surveys of significant increases in condom use and awareness of HIV status, especially among youth.ConclusionsOur analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates. We also show the need to determine the impact of ART on observed HIV prevalence levels. The estimation of HIV incidence and ART exposure is crucial to disentangle the concurrent impact of prevention and treatment programs on HIV prevalence.
Highlights
Worldwide, South Africa has the highest number of HIV infected individuals, with about 5.3 million people living with HIV/AIDS, representing a quarter of the burden of HIV infection in sub-Saharan Africa [1,2]
Our analysis demonstrates how serial measures of HIV prevalence obtained in population-based surveys can be used to estimate national HIV incidence rates
We show the need to determine the impact of antiretroviral treatment (ART) on observed HIV prevalence levels
Summary
South Africa has the highest number of HIV infected individuals, with about 5.3 million people living with HIV/AIDS, representing a quarter of the burden of HIV infection in sub-Saharan Africa [1,2]. The National HIV&AIDS and STI Strategic Plan 2007–2011 has begun to address this enormous challenge for South Africa [3]. The two primary goals of the plan are to reduce the HIV incidence rate by 50% and to expand the access to antiretroviral treatment (ART) to 80% of people who need it. The interpretation of HIV prevalence trends in South Africa is increasingly complex as the epidemic matured and prevention and treatment programmes are implemented at the same time. Increased access to ART has increased the survival time of people living with HIV, with the effect that HIV prevalence is expected to increase in the age groups who are predominantly receiving ART. The estimation of HIV incidence is crucial in this evolving scenario in order to disentangle the impact of prevention and treatment programs on HIV prevalence. A novelty of the 2008 survey was the addition of serological testing to ascertain antiretroviral treatment (ART) use
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