Abstract
BackgroundHIV is prevalent in Sofala Province, Mozambique. To inform future prevention research, we undertook a study in the provincial capital (Beira) to measure HIV incidence in women at higher risk of HIV and assess the feasibility of recruiting and retaining them as research participants.MethodsWomen age 18–35 were recruited from schools and places where women typically meet potential sexual partners. Eligibility criteria included HIV-seronegative status and self-report of at least 2 sexual partners in the last month. History of injection drug use was an exclusion criterion, but pregnancy was not. Participants were scheduled for monthly follow-up for 12 months, when they underwent face-to-face interviews, HIV counseling and testing, and pregnancy testing.Results387 women were eligible and contributed follow-up data. Most were from 18–24 years old (median 21). Around one-third of participants (33.8%) reported at least one new sexual partner in the last month. Most women (65.5%) reported not using a modern method of contraception at baseline. Twenty-two women seroconverted for a prospective HIV incidence of 6.5 per 100 woman-years (WY; 95% confidence interval (CI): 4.1–9.9). Factors associated with HIV seroconversion in the multivariable analysis were: number of vaginal sex acts without using condoms with partners besides primary partner in the last 7 days (hazard ratio (HR) 1.7; 95% CI: 1.2–2.5) and using a form of contraception at baseline other than hormonal or condoms (vs. no method; HR 25.3; 95% CI: 2.5–253.5). The overall retention rate was 80.0% for the entire follow-up period.ConclusionsWe found a high HIV incidence in a cohort of young women reporting risky sexual behavior in Beira, Mozambique. HIV prevention programs should be strengthened. Regular HIV testing and condom use should be encouraged, particularly among younger women with multiple sexual partners.
Highlights
Mozambique, home to roughly 24 million people [1], is one of the Southern African countries hardest hit by the HIV/AIDS epidemic [2]
HIV infection (p#0.05) were having had more than two sexual partners in the last month (HR 2.6; 95% confidence interval (CI): 1.1–6.0), having had a new sexual partner in the last month (HR 2.4; 95% CI: 1.0–5.6), number of vaginal sex acts without using condoms with other partners besides primary partner in the last 7 days (HR 1.6; 95% CI: 1.1–2.2) and using a form of contraception other than condoms, pills or injectables at baseline (HR 12.5; 95% CI: 1.6– 99.1)
The HIV prevalence may be stabilizing in Sofala Province, but that plateau can obscure a high HIV incidence in selected population segments, as has been reported in other regions of sub-Saharan Africa [9]
Summary
Mozambique, home to roughly 24 million people [1], is one of the Southern African countries hardest hit by the HIV/AIDS epidemic [2]. The national adult HIV/AIDS prevalence is 11.5% [4], with the majority of new HIV infections acquired through heterosexual contact. Mozambique’s high HIV prevalence rates first emerged in the central region, along the main transport corridor of Beira [5]. Beira is the capital of central Sofala Province and is Mozambique’s second largest city with around 546,000 people (2007 census), on the Indian Ocean with major commercial transit links to Zimbabwe, Zambia and Malawi. In 2009 national surveillance, 17.8% of women and 12.6% of men aged 15–49 years old were HIV-infected in Sofala Province, higher than the national gender-specific prevalence rates [4]. To inform future prevention research, we undertook a study in the provincial capital (Beira) to measure HIV incidence in women at higher risk of HIV and assess the feasibility of recruiting and retaining them as research participants
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