Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial

Jairam R. Lingappa, Barrot Lambdin, Elizabeth Ann Bukusi, Kenneth Ngure, Linda Kavuma, Mubiana Inambao, William Kanweka, Susan Allen, James N. Kiarie, Joseph Makhema, Edwin Were, Rachel Manongi, David Coetzee, Guy de Bruyn, Sinead Delany-Moretlwe, Amalia Magaret, Nelly Mugo, Andrew Mujugira, Patrick Ndase, Connie Celum & 12 others Craig Cohen, Carey Farquhar, Grace John-Stewart, Elly Katabira, Allan Ronald, Max Essex, Kenneth Fife, Saidi Kapiga, Alana deKock, Glenda Gray, James McIntyre, Helen Rees

Research output: Contribution to journalArticle

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Abstract

Background. Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regignal differences in HIV-1 discordance among African couples, has not previously been reported. Methodology & Principal Findings. The Partners in Prevention HSV-2/ HIV-1 Transmission Trial ("Partners HSV-2 Study"), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 200). Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8-31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r=0.74, p=0.09). Conclusions/Significance. HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials.

Original languageEnglish
Article numbere1411
JournalPLoS One
Volume3
Issue number1
DOIs
StatePublished - Jan 9 2008

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Human immunodeficiency virus 1
HIV-1
Testing
Health care
Human Herpesvirus 2
counseling
health services
Counseling

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial. / Lingappa, Jairam R.; Lambdin, Barrot; Bukusi, Elizabeth Ann; Ngure, Kenneth; Kavuma, Linda; Inambao, Mubiana; Kanweka, William; Allen, Susan; Kiarie, James N.; Makhema, Joseph; Were, Edwin; Manongi, Rachel; Coetzee, David; de Bruyn, Guy; Delany-Moretlwe, Sinead; Magaret, Amalia; Mugo, Nelly; Mujugira, Andrew; Ndase, Patrick; Celum, Connie; Cohen, Craig; Farquhar, Carey; John-Stewart, Grace; Katabira, Elly; Ronald, Allan; Essex, Max; Fife, Kenneth; Kapiga, Saidi; deKock, Alana; Gray, Glenda; McIntyre, James; Rees, Helen.

In: PLoS One, Vol. 3, No. 1, e1411, 09.01.2008.

Research output: Contribution to journalArticle

Lingappa, JR, Lambdin, B, Bukusi, EA, Ngure, K, Kavuma, L, Inambao, M, Kanweka, W, Allen, S, Kiarie, JN, Makhema, J, Were, E, Manongi, R, Coetzee, D, de Bruyn, G, Delany-Moretlwe, S, Magaret, A, Mugo, N, Mujugira, A, Ndase, P, Celum, C, Cohen, C, Farquhar, C, John-Stewart, G, Katabira, E, Ronald, A, Essex, M, Fife, K, Kapiga, S, deKock, A, Gray, G, McIntyre, J & Rees, H 2008, 'Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial', PLoS One, vol. 3, no. 1, e1411. https://doi.org/10.1371/journal.pone.0001411
Lingappa, Jairam R. ; Lambdin, Barrot ; Bukusi, Elizabeth Ann ; Ngure, Kenneth ; Kavuma, Linda ; Inambao, Mubiana ; Kanweka, William ; Allen, Susan ; Kiarie, James N. ; Makhema, Joseph ; Were, Edwin ; Manongi, Rachel ; Coetzee, David ; de Bruyn, Guy ; Delany-Moretlwe, Sinead ; Magaret, Amalia ; Mugo, Nelly ; Mujugira, Andrew ; Ndase, Patrick ; Celum, Connie ; Cohen, Craig ; Farquhar, Carey ; John-Stewart, Grace ; Katabira, Elly ; Ronald, Allan ; Essex, Max ; Fife, Kenneth ; Kapiga, Saidi ; deKock, Alana ; Gray, Glenda ; McIntyre, James ; Rees, Helen. / Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial. In: PLoS One. 2008 ; Vol. 3, No. 1.
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AU - Lingappa, Jairam R.

AU - Lambdin, Barrot

AU - Bukusi, Elizabeth Ann

AU - Ngure, Kenneth

AU - Kavuma, Linda

AU - Inambao, Mubiana

AU - Kanweka, William

AU - Allen, Susan

AU - Kiarie, James N.

AU - Makhema, Joseph

AU - Were, Edwin

AU - Manongi, Rachel

AU - Coetzee, David

AU - de Bruyn, Guy

AU - Delany-Moretlwe, Sinead

AU - Magaret, Amalia

AU - Mugo, Nelly

AU - Mujugira, Andrew

AU - Ndase, Patrick

AU - Celum, Connie

AU - Cohen, Craig

AU - Farquhar, Carey

AU - John-Stewart, Grace

AU - Katabira, Elly

AU - Ronald, Allan

AU - Essex, Max

AU - Fife, Kenneth

AU - Kapiga, Saidi

AU - deKock, Alana

AU - Gray, Glenda

AU - McIntyre, James

AU - Rees, Helen

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N2 - Background. Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regignal differences in HIV-1 discordance among African couples, has not previously been reported. Methodology & Principal Findings. The Partners in Prevention HSV-2/ HIV-1 Transmission Trial ("Partners HSV-2 Study"), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 200). Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8-31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r=0.74, p=0.09). Conclusions/Significance. HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials.

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