High HIV incidence in a community with high HIV prevalence in rural South Africa: findings from a prospective population-based study
High HIV incidence in a community with high HIV prevalence in rural South Africa: findings from a prospective population-based study
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DOI：
10.1097/qad.0b013e3282f2ef43
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发表时间：
2008-01-02
期刊：
影响因子：
3.8
通讯作者：
Newell, Marie-Louise
中科院分区：
文献类型：
--
作者：
Barnighausen, Till;Tanser, Frank;Newell, Marie-Louise
目的：通过一项基于人群的前瞻性队列研究，测量南非农村地区HIV高流行率地区的HIV发病率，并分析感染HIV的危险因素。方法：采用两轮（2003-2005）夸祖鲁-纳塔尔省农村大规模前瞻性人群艾滋病毒调查的数据，按性别和5岁年龄组计算艾滋病毒感染率。采用多重归算（Multiple imputations， MI）对选择效应进行调整，并采用Weibull多元回归对感染HIV的危险因素进行检验。结果：在5253人年的风险中，170人血清呈阳性。15-49岁女性每100人年的HIV粗感染率为3.8[95%可信区间（Cl）， 3.2-4.6]， 15-54岁男性为2.3（95%可信区间，1.8-3.1）。心肌梗死显著增加了女性和男性的HIV感染率[分别为7.9/100人年（95% Cl, 7.4-8.4）和5.1/100人年（95% Cl, 4.1-6.2）]。在Weibull多元回归中保持其他因素不变时，目前未婚但有伴侣的人群的HIV血清转化风险大约是已婚人群的两倍（P < 0.001），并且随着距离政府卫生诊所的距离增加（P=0.051）和距离主要道路的距离减少（P=0.002）而增加。结论：在南非农村这个艾滋病高发社区，艾滋病发病率非常高。目前对抗逆转录病毒治疗的重视需要与重新强调对两性的艾滋病毒预防相平衡。(c) 2008年威科集团健康公司。
Objectives: To measure HIV incidence in a rural area of South Africa with high HIV prevalence and to analyze risk factors for acquisition of HIV using a prospective population-based cohort study.Methods: Data from two rounds (2003-2005) of a large prospective population-based HIV survey in rural KwaZulu-Natal were used to calculate HIV incidence by sex and 5-year age group. Multiple imputations (MI) were used to adjust for selection effects and risk factors for acquiring HIV were examined in Weibull multiple regression.Results: During 5253 person-years at risk, 170 individuals became seropositive. The crude HIV incidence rate per 100 person-years was 3.8 [95% confidence interval (Cl), 3.2-4.6] in women aged 15-49 years and 2.3 (95% Cl, 1.8-3.1) in men aged 15-54 years. MI significantly increased the HIV incidence rates both in women and men [7.9/100 person-years (95% Cl, 7.4-8.4) and 5.1/100person-years (95% Cl 4.1-6.2), respectively]. When holding other factors constant in Weibull multiple regression, the hazard of HIV seroconversion was approximately twice as high in people who were currently unmarried but had a partner than among people who were currently married (P < 0.001) and increased with increasing distance from a government health clinic (P=0.051) and decreasing distance from a primary road (P=0.002).Conclusion: In this high HIV prevalence community in rural South Africa HIV incidence is very high. The present focus on antiretroviral treatment needs to be balanced with a renewed emphasis on HIV prevention for both sexes. (c) 2008 Wolters Kluwer Health.