Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study.
Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study.
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DOI：
10.1371/journal.pone.0001954
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发表时间：
2008-04-16
期刊：
影响因子：
3.7
通讯作者：
CAPRISA 002 Acute Infection Study Team
中科院分区：
文献类型：
--
作者：
van Loggerenberg F;Mlisana K;Williamson C;Auld SC;Morris L;Gray CM;Abdool Karim Q;Grobler A;Barnabas N;Iriogbe I;Abdool Karim SS;CAPRISA 002 Acute Infection Study Team
描述南非HIV感染高危队列的基线人口统计学数据、临床特征和HIV发病率，以及在建立和维持队列过程中遇到的挑战。2004年8月至2005年5月期间，为CAPRISA 002急性感染研究（HIV-1亚型C感染的自然史研究）建立了一组未感染艾滋病毒的妇女。志愿人员是通过同行外联确定的。每月对该队列进行随访，以确定HIV感染率和早期HIV感染的临床表现。提供了减少风险咨询以及男用和女用避孕套。在筛选了775名个体后，建立了一个由245名未感染的高危妇女组成的队列。筛查时的艾滋病毒感染率为59.6%（95% CI：55.9%至62.8%），这对招募未感染艾滋病毒的妇女构成了挑战。大多数妇女（78.8%）自称是性工作者，平均每天接待2名顾客。大多数女性（95%）表示在过去3个月内有不止一名临时性伴侣（不包括客户），58.8%的女性表示在上次性行为中使用了避孕套。根据实验室检测，62.0%的患者在基线时有性传播感染。在390人-年的随访中，发生了28例感染，血清发病率为7.2（95%CI：4.5 - 9.8）/100人-年。尽管该性工作者群体的流动性很高，但2年后的保留率留存率为86.1%。高并发症在人力和财政资源方面给辅助护理的提供带来了挑战。所面临的挑战是艾滋病毒基线流行率高，艾滋病毒发病率低于预期，难以留住参与者。尽管面临挑战，我们已经成功地积累了这一队列的艾滋病毒未感染的妇女与有利的保留，使我们能够研究艾滋病毒-1在急性艾滋病毒感染的自然史。我们的经验为建立类似队列的其他人提供了经验教训，这将是在资源有限的情况下推进疫苗和预防研究议程的关键。
To describe the baseline demographic data, clinical characteristics and HIV-incidence rates of a cohort at high risk for HIV infection in South Africa as well as the challenges experienced in establishing and maintaining the cohort. Between August 2004 and May 2005 a cohort of HIV-uninfected women was established for the CAPRISA 002 Acute Infection Study, a natural history study of HIV-1 subtype C infection. Volunteers were identified through peer-outreach. The cohort was followed monthly to determine HIV infection rates and clinical presentation of early HIV infection. Risk reduction counselling and male and female condoms were provided. After screening 775 individuals, a cohort of 245 uninfected high-risk women was established. HIV-prevalence at screening was 59.6% (95% CI: 55.9% to 62.8%) posing a challenge in accruing HIV-uninfected women. The majority of women (78.8%) were self-identified as sex-workers with a median of 2 clients per day. Most women (95%) reported more than one casual sexual partner in the previous 3 months (excluding clients) and 58.8% reported condom use in their last sexual encounter. Based on laboratory testing, 62.0% had a sexually transmitted infection at baseline. During 390 person-years of follow-up, 28 infections occurred yielding seroincidence rate of 7.2 (95% CI: 4.5 to 9.8) per 100 person-years. Despite the high mobility of this sex worker cohort retention rate after 2 years was 86.1%. High co-morbidity created challenges for ancillary care provision, both in terms of human and financial resources. Challenges experienced were high baseline HIV-prevalence, lower than anticipated HIV-incidence and difficulties retaining participants. Despite challenges, we have successfully accrued this cohort of HIV-uninfected women with favourable retention, enabling us to study the natural history of HIV-1 during acute HIV-infection. Our experiences provide lessons for others establishing similar cohorts, which will be key for advancing the vaccine and prevention research agenda in resource-constrained settings.