Household survey of HIV incidence in Rwanda: a national observational cohort study
Household survey of HIV incidence in Rwanda: a national observational cohort study
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DOI：
10.1016/s2352-3018(17)30124-8
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发表时间：
2017-10-01
期刊：
影响因子：
16.1
通讯作者：
Bucher, Heiner C.
中科院分区：
文献类型：
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作者：
Nsanzimana, Sabin;Remera, Eric;Bucher, Heiner C.
背景 在卢旺达，自 2005 年以来，15-49 岁成年人中的艾滋病毒感染率一直稳定在 3%。本研究的目的是了解整个卢旺达的艾滋病毒发病率。方法 我们在 2013-14 年期间进行了一项具有全国代表性的前瞻性艾滋病毒发病率调查，该调查采用了两阶段抽样。第一阶段随机抽取492个村，第二阶段每个村随机抽取14户。参与者填写了一份调查问卷，并对 14140 人进行了艾滋病毒检测。 13728 名 HIV 阴性参与者被纳入发病队列。 12 个月后，参与者再次接受测试和调查。权重计算为选择村庄和家庭的概率的倒数。 结果 研究时间为2013年11月5日至2014年11月15日。在来自6792个家庭的14222名受访者中，14140人接受了艾滋病毒检测，13728人艾滋病毒呈阴性。在参与终点数据收集活动的 12593 人中，5965 人（47.4%）为男性，平均年龄为 30 岁（SD 10.8）。 11237 名（89.2%）参与者居住在农村地区，4826 名（38.3%）单身，7140 名（56.7%）已婚或同居。年内，有 35 名参与者出现血清转化，其中包括 13 名男性和 22 名女性，总发病率为每 100 人年 0.27 例（95% CI 0.18-0.35）。男性发病率为每 100 人年 0.21 例 (0.10-0.32)，女性发病率为每 100 人年 0.32 例 (0.19-0.45)。我们的研究结果表明，在三个村庄和两个家庭中发生了多次爆发，并发生了多次血清转化。与 16-25 岁人群相比，36-45 岁成年人的发病率较高（0.37/100 人年，0.12-0.62；调整后风险比 [aHR] 4.49，95% CI 1.30-14.70），西部省份发病率更高（0.57/100 人年，0.31-0.87；aHR 5.90, 1.33-25.28）相对于北部省份，城市地区（0.65/100人年，0.23-1.07；aHR 3.10, 1.28-6.99）高于农村地区。 解释 卢旺达的艾滋病毒发病率高于先前根据模型估计的发病率，疫情的爆发似乎加剧了该流行病的持续发展。事件感染的特征可以帮助国家艾滋病毒规划针对高危人群制定预防性干预措施。为全球抗击艾滋病毒、结核病和疟疾基金、世界卫生组织卢旺达、联合国艾滋病规划署卢旺达和卢旺达政府提供资金。
Background In Rwanda, HIV prevalence among adults aged 15-49 years has been stable at 3% since 2005. The aim of this study was to characterise HIV incidence across Rwanda.Methods We did a nationally representative, prospective HIV incidence survey for the period of 2013-14, which used two-stage sampling. We randomly selected 492 villages in the first sampling stage and 14 households per village in the second stage. Participants completed a questionnaire and 14140 people were tested for HIV. 13728 participants were HIV negative, and were enrolled in the incidence cohort. Participants were retested and surveyed again after 12 months. Weights were calculated as the inverse of the probability to select the villages and the households.Findings The study period was from Nov 5, 2013, to Nov 15, 2014. Among 14222 respondents from 6792 households, 14140 were tested for HIV and 13728 were HIV negative. Of 12593 people who participated in the endpoint data collection activities, 5965 (47.4%) were men and the mean age was 30 years (SD 10.8). 11237 (89.2%) participants lived in rural areas, 4826 (38.3%) were single, and 7140 (56.7%) were married or cohabitating. During the year, 35 participants had seroconversion, including 13 men and 22 women, resulting in an overall incidence of 0.27 per 100 person-years (95% CI 0.18-0.35). Incidence was 0.21 per 100 person-years (0.10-0.32) in men and 0.32 per 100 person-years (0.19-0.45) in women. Our findings suggested multiple breakouts, with multiple seroconversions occurring in three villages and two households. Incidence was higher in adults aged 36-45 years (0.37 per 100 person-years, 0.12-0.62; adjusted hazard ratio [aHR] 4.49, 95% CI 1.30-14.70) relative to those aged 16-25, higher in western province (0.57 per 100 person-years, 0.31-0.87; aHR 5.90, 1.33-25.28) relative to the northern province, and higher in urban areas (0.65 per 100 person-years, 0.23-1.07; aHR 3.10, 1.28-6.99) than in rural areas.Interpretation The incidence of HIV in Rwanda was higher than that previously estimated from models, with outbreaks seeming to contribute to the ongoing epidemic. Characterisation of incident infections can help the national HIV programmes to plan for preventive interventions tailored to the most at risk populations.Funding Global Fund to Fight HIV, Tuberculosis and Malaria, WHO Rwanda, UNAIDS Rwanda, and the Government of Rwanda.