Lack of a Decline in HIV Incidence in a Rural Community with High HIV Prevalence in South Africa, 2003-2007
Lack of a Decline in HIV Incidence in a Rural Community with High HIV Prevalence in South Africa, 2003-2007
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DOI：
10.1089/aid.2008.0211
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发表时间：
2009-04-01
影响因子：
1.5
通讯作者：
Newell, Marie-Louise
中科院分区：
文献类型：
--
作者：
Baernighausen, Till;Tanser, Frank;Newell, Marie-Louise
为了了解艾滋病毒流行的动态并规划艾滋病毒治疗和预防计划，了解人群中艾滋病毒发病率如何随时间变化至关重要。我们使用南非农村社区大规模人群纵向艾滋病毒监测数据来测试该人群的艾滋病毒发病率在 2003 年至 2007 年期间是否发生了变化。我们观察到 16,256 人年的 8095 名个体中有 563 例血清转化，得出总体艾滋病毒发病率为每 100 人年 3.4 例（95% 置信区间 3.1-3.7）。我们在年龄分层 Cox 回归中纳入了时间相关的周期虚拟变量（以半年增量），以测试 HIV 发病率的趋势。我们首先分别对女性和男性进行回归分析。在这两个回归中，所有期间虚拟变量的系数单独不显着（所有 p >= 0.338）和联合不显着（分别为 p=0.764 和 p=0.111）。然后，我们使用女性和男性的汇总数据进行回归分析，控制性别以及性别和年龄之间的相互作用。同样，八个周期虚拟变量的系数单独不显着（所有 p >= 0.387）和联合不显着（p=0.701）。我们首次表明，在艾滋病毒高感染率的南非农村社区，过去 5 年里，女性和男性的艾滋病毒发病率一直保持在高水平，没有任何下降的迹象。如果不采取新的或加强的措施来预防艾滋病毒感染，南非农村地区的艾滋病毒流行趋势就不可能逆转。
To understand the dynamics of the HIV epidemic and to plan HIV treatment and prevention programs, it is critical to know how HIV incidence in a population evolves over time. We used data from a large population-based longitudinal HIV surveillance in a rural community in South Africa to test whether HIV incidence in this population has changed in the period from 2003 through 2007. We observed 563 seroconversions in 8095 individuals over 16,256 person-years at risk, yielding an overall HIV incidence of 3.4 per 100 person-years (95% confidence interval 3.1-3.7). We included time-dependent period dummy variables (in half-yearly increments) in age-stratified Cox regressions in order to test for trends in HIV incidence. We first did regression analyses separately for women and men. In both regressions, the coefficients of all period dummy variables were individually insignificant (all p >= 0.338) and jointly insignificant (p=0.764 and p=0.111, respectively). We then did regression analysis using the pooled data on women and men, controlling for sex and interactions between sex and age. Again, the coefficients of the eight period dummy variables were individually insignificant (all p >= 0.387) and jointly insignificant (p=0.701). We show for the first time that high levels of HIV incidence have been maintained without any sign of decline over the past 5 years in both women and men in a rural South African community with high HIV prevalence. It is unlikely that the HIV epidemic in rural South Africa can be reversed without new or intensified efforts to prevent HIV infection.