Sources of HIV incidence among stable couples in sub-Saharan Africa |
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Authors: | Hiam Chemaitelly Susanne F Awad James D Shelton Laith J Abu-Raddad |
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Affiliation: | 1.Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar;2.Bureau for Global Health, United States Agency for International Development, Washington, DC, USA;3.Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, USA;4.Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, DC, USA |
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Abstract: | IntroductionThe recent availability of efficacious prevention interventions among stable couples offers new opportunities for reducing HIV incidence in sub-Saharan Africa. Understanding the dynamics of HIV incidence among stable couples is critical to inform HIV prevention strategy across sub-Saharan Africa.MethodsWe quantified the sources of HIV incidence arising among stable couples in sub-Saharan Africa using a cohort-type mathematical model parameterized by nationally representative data. Uncertainty and sensitivity analyses were incorporated.ResultsHIV incidence arising among stable concordant HIV-negative couples contribute each year, on average, 29.4% of total HIV incidence; of those, 22.5% (range: 11.1%–39.8%) are infections acquired by one of the partners from sources external to the couple, less than 1% are infections acquired by both partners from external sources within a year and 6.8% (range: 3.6%–11.6%) are transmissions to the uninfected partner in the couple in less than a year after the other partner acquired the infection from an external source. The mean contribution of stable HIV sero-discordant couples to total HIV incidence is 30.4%, with most of those, 29.7% (range: 9.1%–47.9%), being due to HIV transmissions from the infected to the uninfected partner within the couple. The remaining incidence, 40.2% (range: 23.7%–64.6%), occurs among persons not in stable couples.ConclusionsClose to two-thirds of total HIV incidence in sub-Saharan Africa occur among stable couples; however, only half of this incidence is attributed to HIV transmissions from the infected to the uninfected partner in the couple. The remaining incidence is acquired through extra-partner sex. Substantial reductions in HIV incidence can be achieved only through a prevention approach that targets all modes of HIV exposure among stable couples and among individuals not in stable couples. |
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Keywords: | stable couples sources of infection HIV incidence Sub-Saharan Africa demographic and health surveys mathematical model |
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