HIV epidemic drivers in South Africa : a model-based evaluation of factors accounting for inter-provincial differences in HIV prevalence and incidence trends

Background: HIV prevalence differs substantially between South Africa’s provinces, but the factors accounting for this difference are poorly understood.Objectives: To estimate HIV prevalence and incidence trends by province, and to identify the epidemiological factors that account for most of the va...

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Vydané v:Southern African journal of HIV medicine Ročník 18; číslo 1; s. 1 - 9
Hlavní autori: Johnson, Leigh F., Dorrington, Rob E., Moolla, Haroon
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: South Africa AOSIS 2017
African Online Scientific Information Systems (Pty) Ltd t/a AOSIS
AOSIS (Pty) Ltd
Southern African HIV Clinicians Society
Predmet:
Acquired immune deficiency syndrome
AIDS
Analysis
Bayesian analysis
Bias
Biology
Circumcision
Demography
Epidemics
Epidemiology
Health Care Sciences & Services
Health Policy & Services
Health risk assessment
HIV
HIV/AIDS
Human immunodeficiency virus
Immunology
male circumcision
Males
Mathematical models
Motor vehicle drivers
Original Research
Prevention
Sexual behavior
sexual behaviour
South Africa
ISSN:1608-9693, 2078-6751, 2078-6751
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Shrnutí:Background: HIV prevalence differs substantially between South Africa’s provinces, but the factors accounting for this difference are poorly understood.Objectives: To estimate HIV prevalence and incidence trends by province, and to identify the epidemiological factors that account for most of the variation between provinces.Methods: A mathematical model of the South African HIV epidemic was applied to each of the nine provinces, allowing for provincial differences in demography, sexual behaviour, male circumcision, interventions and epidemic timing. The model was calibrated to HIV prevalence data from antenatal and household surveys using a Bayesian approach. Parameters estimated for each province were substituted into the national model to assess sensitivity to provincial variations.Results: HIV incidence in 15–49-year-olds peaked between 1997 and 2003 and has since declined steadily. By mid-2013, HIV prevalence in 15–49-year-olds varied between 9.4% (95% CI: 8.5%–10.2%) in Western Cape and 26.8% (95% CI: 25.8%–27.6%) in KwaZulu-Natal. When standardising parameters across provinces, this prevalence was sensitive to provincial differences in the prevalence of male circumcision (range 12.3%–21.4%) and the level of non-marital sexual activity (range 9.5%–24.1%), but not to provincial differences in condom use (range 17.7%–21.2%), sexual mixing (range 15.9%–19.2%), marriage (range 18.2%–19.4%) or assumed HIV prevalence in 1985 (range 17.0%–19.1%).Conclusion: The provinces of South Africa differ in the timing and magnitude of their HIV epidemics. Most of the heterogeneity in HIV prevalence between South Africa’s provinces is attributable to differences in the prevalence of male circumcision and the frequency of non-marital sexual activity.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1608-9693
2078-6751
2078-6751
DOI:10.4102/sajhivmed.v18i1.695