Abstract
Over the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.
Highlights
Over the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV
Population-based cohort from a hyperendemic South African setting, we demonstrate a 43% decline in the incidence of HIV infection between 2012 and 2017
Men experienced an earlier and larger decline in incidence, which we attribute to the introduction of a local voluntary medical male circumcision (VMMC) program in 2009, the scale-up of national testing and counseling services in 2010, and female antiretroviral therapy (ART) coverage surpassing 35% in 2012
Summary
There has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. The impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. There has been a massive scale-up of treatment and prevention services to bring the HIV epidemic under control[1] These efforts have led to an estimated 50% reduction in the number of AIDS-related deaths over the last 6 years[2]. Reductions in incidence have not been rigorously demonstrated using a prospectively followed, population-based cohort from southern Africa, which has a much higher rate of new HIV infections and has received substantial domestic and international investment to achieve epidemic control[1,4]. One major challenge in reliably measuring HIV incidence trends in southern Africa (as well as the broader African region) has been the limited number of population-based cohort studies
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call