The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019
Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs. We calibrated a mathematical model of the South African HIV epid...
Saved in:
| Published in: | Journal of acquired immune deficiency syndromes (1999) Vol. 90; no. 2; p. 115 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
01.06.2022
|
| ISSN: | 1944-7884, 1944-7884 |
| Online Access: | Get more information |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Abstract | Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs.
We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented.
The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women.
HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline. |
|---|---|
| AbstractList | Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs.BACKGROUNDRecent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs.We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented.METHODSWe calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented.The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women.RESULTSThe model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women.HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline.CONCLUSIONSHIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline. Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs. We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented. The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women. HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline. |
| Author | Seathlodi, Thapelo Johnson, Leigh F Zuma, Khangelani Feizzadeh, Ali Puren, Adrian Dorrington, Rob E Meyer-Rath, Gesine |
| Author_xml | – sequence: 1 givenname: Leigh F surname: Johnson fullname: Johnson, Leigh F organization: Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa – sequence: 2 givenname: Gesine surname: Meyer-Rath fullname: Meyer-Rath, Gesine organization: Department of Global Health, Boston University School of Public Health, Boston, MA – sequence: 3 givenname: Rob E surname: Dorrington fullname: Dorrington, Rob E organization: Centre for Actuarial Research, School of Management Studies, University of Cape Town, Cape Town, South Africa – sequence: 4 givenname: Adrian surname: Puren fullname: Puren, Adrian organization: Division of Virology, School of Pathology, University of Witwatersrand, Johannesburg, South Africa – sequence: 5 givenname: Thapelo surname: Seathlodi fullname: Seathlodi, Thapelo organization: Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa – sequence: 6 givenname: Khangelani surname: Zuma fullname: Zuma, Khangelani organization: Human Sciences Research Council, Pretoria, South Africa; and – sequence: 7 givenname: Ali surname: Feizzadeh fullname: Feizzadeh, Ali organization: UNAIDS, Pretoria, South Africa |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35125471$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkEtLAzEUhYNU7EP_gUiWLpyaZNKkWZbS2oHiA2u3Q552ZCapyczCf2_VCr13cQ6cj8vhDkHPB28BuMZojJHg9y-zYoxOhgjCz8AAC0ozPp3S3onvg2FKHwhhRqm4AP18gsmEcjwA283OwoVzVrcwOLgqtvA5hvcomwQrD19D1-7gzMVKSxg8fJRtFbysf8HC68pYry3cROtNuoPk0CMjCItLcO5knezVUUfgbbnYzFfZ-umhmM_WmaaE4Uwo7CyzSFKRSyeJplwLhHPCJEeUI0F-IuUUMSyfTLVWGDFhDHdCGSkUGYHbv7v7GD47m9qyqZK2dS29DV0qCTss4bkQB_TmiHaqsabcx6qR8av8_wX5BsnXX5E |
| CitedBy_id | crossref_primary_10_1001_jama_2025_5180 crossref_primary_10_1093_cid_ciae652 crossref_primary_10_4102_phcfm_v15i1_3678 crossref_primary_10_1097_QAD_0000000000004205 crossref_primary_10_4102_hsag_v30i0_3084 crossref_primary_10_1016_S0140_6736_24_02438_3 crossref_primary_10_1097_QAD_0000000000003728 crossref_primary_10_1097_COH_0000000000000818 crossref_primary_10_1016_S2214_109X_25_00281_5 crossref_primary_10_1136_bmjgh_2023_013376 crossref_primary_10_3389_fgwh_2024_1505643 crossref_primary_10_1007_s10461_024_04609_3 crossref_primary_10_1186_s12913_023_10331_y crossref_primary_10_1016_j_ssmqr_2022_100148 crossref_primary_10_1155_2023_6662437 crossref_primary_10_1016_j_drugpo_2025_104894 crossref_primary_10_1016_S2352_3018_24_00295_9 crossref_primary_10_1038_s41416_024_02937_8 crossref_primary_10_1016_S2352_3018_24_00212_1 crossref_primary_10_7196_SAMJ_2022_v112i8b_16648 crossref_primary_10_3389_fpubh_2023_1061339 crossref_primary_10_1097_QAI_0000000000003657 crossref_primary_10_1017_S0021932024000208 crossref_primary_10_3390_ijerph192315636 crossref_primary_10_1016_S2214_109X_25_00121_4 crossref_primary_10_1016_S2214_109X_24_00553_9 crossref_primary_10_3390_mps7060089 crossref_primary_10_1016_j_vaccine_2025_127770 crossref_primary_10_3390_diagnostics13152563 crossref_primary_10_1093_phe_phae009 crossref_primary_10_1016_S2214_109X_25_00119_6 crossref_primary_10_1016_j_vaccine_2024_06_029 crossref_primary_10_1080_23744235_2025_2557628 crossref_primary_10_1007_s40473_025_00298_x crossref_primary_10_7326_ANNALS_24_01104 crossref_primary_10_1002_jia2_26230 crossref_primary_10_4102_sajhivmed_v26i1_1684 crossref_primary_10_1097_QAI_0000000000003642 crossref_primary_10_1186_s12879_023_08470_y crossref_primary_10_3390_genes15091173 |
| ContentType | Journal Article |
| Copyright | Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. |
| Copyright_xml | – notice: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. |
| DBID | NPM 7X8 |
| DOI | 10.1097/QAI.0000000000002927 |
| DatabaseName | PubMed MEDLINE - Academic |
| DatabaseTitle | PubMed MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic PubMed |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1944-7884 |
| ExternalDocumentID | 35125471 |
| Genre | Journal Article |
| GroupedDBID | --- .-D .XZ .Z2 01R 0R~ 1J1 354 40H 4Q1 4Q2 4Q3 5GY 5RE 5VS 77Y 7O~ 8L- AAAAV AAAXR AAGIX AAHPQ AAIQE AAJCS AAMOA AAQKA AARTV AASCR AASOK AASXQ AAXQO ABASU ABBUW ABDIG ABIVO ABVCZ ABXVJ ABZAD ACDDN ACEWG ACGFO ACGFS ACIJW ACILI ACLDA ACOAL ACPRK ACWDW ACWRI ACXJB ACXNZ ADGGA ADHPY AE3 AE6 AEBDS AFDTB AFEXH AFRAH AFUWQ AGINI AHMBA AHOMT AHQNM AHVBC AIJEX AINUH AJCLO AJIOK AJNWD AJZMW AKCTQ AKULP ALKUP ALMA_UNASSIGNED_HOLDINGS ALMTX AMJPA AMKUR AMNEI AOHHW AWKKM BKOMP BOYCO BQLVK BYPQX C45 CS3 DIWNM E.X EBS EEVPB ERAAH EX3 F2K F2L F2M F2N F5P FCALG FL- FRJ FRP GNXGY GQDEL H0~ HLJTE HZ~ IKREB IKYAY IN~ IPNFZ JK3 JK8 K8S KD2 KMI L-C NPM N~7 N~B O9- OAG OAH ODA ODMTH OHH OHYEH OLG OLH OLU OLV OLW OLY OLZ OPUJH OVD OVDNE OVIDH OVLEI OWV OWX OWY OWZ OXXIT P2P PQQKQ RIG RLZ RXW S4R S4S TAE TEORI TSPGW V2I VVN W2D W3M WOQ WOW X3V X3W XYM YOC 7X8 ABPXF ABXYN ABZZY ACBKD ACZKN ADKSD ADSXY AFBFQ AFNMH AHQVU AOQMC |
| ID | FETCH-LOGICAL-c4261-9b1fe6e0a493afa2c47c901326a70470920a49bfb2d6358ccb1069dd7f9bda9b2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 52 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000811052700001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1944-7884 |
| IngestDate | Sun Nov 09 14:04:38 EST 2025 Wed Feb 19 02:25:13 EST 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 2 |
| Language | English |
| License | Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c4261-9b1fe6e0a493afa2c47c901326a70470920a49bfb2d6358ccb1069dd7f9bda9b2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://doi.org/10.1097/qai.0000000000002927 |
| PMID | 35125471 |
| PQID | 2626227399 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2626227399 pubmed_primary_35125471 |
| PublicationCentury | 2000 |
| PublicationDate | 2022-Jun-01 20220601 |
| PublicationDateYYYYMMDD | 2022-06-01 |
| PublicationDate_xml | – month: 06 year: 2022 text: 2022-Jun-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Journal of acquired immune deficiency syndromes (1999) |
| PublicationTitleAlternate | J Acquir Immune Defic Syndr |
| PublicationYear | 2022 |
| SSID | ssj0016449 |
| Score | 2.564578 |
| Snippet | Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 115 |
| Title | The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019 |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/35125471 https://www.proquest.com/docview/2626227399 |
| Volume | 90 |
| WOSCitedRecordID | wos000811052700001&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8NAEF7Uinjx_agvVvBosN1ss52TFLG0YEsFLb2FzT6gIEk16u939lF6EgRzyCVZCJPZmW_n9RFy0zbCVVvYxLalSrgGkwCXWWLTLOtoxQx4SpbpkxiPu7MZTGLArY5llUub6A21rpSLkd8xRN4MfS3A_eI9caxRLrsaKTTWSSNFKOM2ppitsgjo68FnlTl3VXN82ToH4u65NwyjC-PFgInfQaZ3Nv3d_37mHtmJMJP2gl7skzVTHpCtUUykH5IpqgcNk4tpZelgOKWTUKlV03lJPbEeDRxCtCppnJ795l9EkxKYSGkoqL2lvnEcfTwckdf-48vDIIkUC4lyZ6cEirY1mWlJDqm0kikuFLj0SybxH4oWMPeosAXTiEy6ShV4hASthYVCSyjYMdkoq9KcEgrSapEKjustTwtAM6sYs90OogwrVKtJrpcSy1GFXV5Clqb6qvOVzJrkJIg9X4RZG3mKgKSDDvTsD6vPyTZzzQk-RnJBGhY3sLkkm-r7c15_XHndwPt4MvoBFt--bA |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=The+Effect+of+HIV+Programs+in+South+Africa+on+National+HIV+Incidence+Trends%2C+2000-2019&rft.jtitle=Journal+of+acquired+immune+deficiency+syndromes+%281999%29&rft.au=Johnson%2C+Leigh+F&rft.au=Meyer-Rath%2C+Gesine&rft.au=Dorrington%2C+Rob+E&rft.au=Puren%2C+Adrian&rft.date=2022-06-01&rft.issn=1944-7884&rft.eissn=1944-7884&rft.volume=90&rft.issue=2&rft.spage=115&rft_id=info:doi/10.1097%2FQAI.0000000000002927&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1944-7884&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1944-7884&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1944-7884&client=summon |