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Age patterns of HIV incidence in eastern and southern Africa: a collaborative analysis of observational general population cohort studies

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Title: Age patterns of HIV incidence in eastern and southern Africa: a collaborative analysis of observational general population cohort studies
Authors: Risher, K
Cori, A
Reniers, G
Marston, M
Calvert, C
Crampin, A
Dadirai, T
Dube, A
Gregson, S
Herbst, K
Lutalo, T
Moorhouse, L
Mtenga, B
Nabukalu, D
Newton, R
Price, AJ
Tlhajoane, M
Todd, J
Tomlin, K
Urassa, M
Vandormael, A
Fraser, C
Slaymaker, E
Eaton, J
Item Type: Journal Article
Abstract: Background: As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this has changed over the epidemic is needed to guide HIV prevention. We assessed trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in average age at infection, age distribution of new infections, and birth cohort cumulative incidence. Methods: We used a Bayesian model to reconstruct age-specific HIV incidence from repeated observations of individuals’ HIV serostatus and survival collected among population HIV cohorts in rural Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. The HIV incidence rate by age, time and sex was modelled using smooth splines functions. Incidence trends were estimated separately by sex and study. Estimated incidence and prevalence results for 2000-2017, standardised to study population distribution, were used to estimate average age at infection and proportion of new infections by age. Findings: Age-specific incidence declined at all ages, though the timing and pattern of decline varied by study. The average age at infection was higher in men (cohort means: 27·8-34·6 years) than women (cohort means: 24·8-29·6 years). Between 2000 and 2017, the average age at infection increased slightly: cohort means 0·5-2·8 years among men and -0·2-2·5 years among women. Across studies, between 38-63%(cohort means)of women’s infections were among 15-24-year-olds and between 30-63% of men’s infections were in 20-29-year-olds. Lifetime risk of HIV declined for successive birth cohorts. Interpretation: HIV incidence declined in all age groups and shifted slightly, but not dramatically, to older ages. Disproportionate new HIV infections occur among 15-24-year-old 4women and20-29-year-oldmen, supporting focused prevention in these groups. But 40-60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages.
Issue Date: Jul-2021
Date of Acceptance: 23-Mar-2021
URI: http://hdl.handle.net/10044/1/89058
DOI: 10.1016/S2352-3018(21)00069-2
ISSN: 2405-4704
Publisher: Elsevier
Start Page: e429
End Page: e439
Journal / Book Title: The Lancet HIV
Volume: 8
Issue: 7
Copyright Statement: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Bill & Melinda Gates Foundation
Bill & Melinda Gates Foundation
Wellcome Trust
National Institutes of Health
Funder's Grant Number: OPP1190661
2018/837458-0 PO202048522
Keywords: 11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2021-06-28
Appears in Collections:Faculty of Medicine
School of Public Health

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