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Nat Commun. 2019 Dec 2;10(1):5482. doi: 10.1038/s41467-019-13473-y.

Declines in HIV incidence among men and women in a South African population-based cohort.

Vandormael A1,2,3,4, Akullian A5,6, Siedner M7,8,9, de Oliveira T10,6,11, Bärnighausen T7,12,13, Tanser F7,14,11,15.

Author information

1
Africa Health Research Institute (AHRI), Private Bag X7, Durban, 4013, South Africa. vandormaela@ukzn.ac.za.
2
School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, 4041, South Africa. vandormaela@ukzn.ac.za.
3
Heidelberg Institute for Global Health (HIGH), University of Heidelberg, Heidelberg, 69120, Germany. vandormaela@ukzn.ac.za.
4
KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, UKZN, Durban, 4013, South Africa. vandormaela@ukzn.ac.za.
5
Institute for Disease Modeling, Bellevue, Washington, 98005, USA.
6
Department of Global Health, University of Washington, Seattle, Washington, 98195, USA.
7
Africa Health Research Institute (AHRI), Private Bag X7, Durban, 4013, South Africa.
8
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114, USA.
9
Harvard Medical School, Boston, Massachusetts, 02115, USA.
10
KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, UKZN, Durban, 4013, South Africa.
11
Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, 4013, South Africa.
12
Heidelberg Institute for Global Health (HIGH), University of Heidelberg, Heidelberg, 69120, Germany.
13
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, 02115, USA.
14
School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, 4041, South Africa.
15
Lincoln Institute for Health, University of Lincoln, Lincoln, LN6 7TS, UK.

Abstract

Over the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa-the country with the world's highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.

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