Age patterns of HIV incidence in eastern and southern Africa: a modelling analysis of observational population-based cohort studies.

Autor:	Risher KA; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: krisher@ic.ac.uk., Cori A; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK., Reniers G; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Marston M; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Calvert C; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Crampin A; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK., Dadirai T; The Manicaland Centre for Public Health Research, Harare, Zimbabwe., Dube A; Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi., Gregson S; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe., Herbst K; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; Department of Science and Innovation-Medical Research Council South African Population Research Infrastructure Network, Durban, South Africa., Lutalo T; Rakai Health Sciences Program, Kalisizo, Uganda., Moorhouse L; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK., Mtenga B; National Institute for Medical Research, Kisesa HDSS, Mwanza, Tanzania., Nabukalu D; Rakai Health Sciences Program, Kalisizo, Uganda., Newton R; Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Health Sciences, University of York, York, UK., Price AJ; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Tlhajoane M; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Todd J; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Tomlin K; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Urassa M; National Institute for Medical Research, Kisesa HDSS, Mwanza, Tanzania., Vandormael A; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Innovation and Sequencing Platform, UKZN, Durban, South Africa; Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany., Fraser C; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK., Slaymaker E; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK., Eaton JW; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Jazyk:	angličtina
Zdroj:	The lancet. HIV [Lancet HIV] 2021 Jul; Vol. 8 (7), pp. e429-e439.
DOI:	10.1016/S2352-3018(21)00069-2
Abstrakt:	Background: As the HIV epidemic in sub-Saharan Africa matures, evidence about the age distribution of new HIV infections and how this distribution has changed over the epidemic is needed to guide HIV prevention. We aimed to assess trends in age-specific HIV incidence in six population-based cohort studies in eastern and southern Africa, reporting changes in mean 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, in a collaborative analysis of the ALPHA network. We modelled HIV incidence rates by age, time, and sex using smoothing splines functions. We estimated incidence trends separately by sex and study. We used estimated incidence and prevalence results for 2000-17, standardised to study population distribution, to estimate mean age at infection and proportion of new infections by age. We also estimated cumulative incidence (lifetime risk of infection) by birth cohort. Findings: Age-specific incidence declined at all ages, although the timing and pattern of decline varied by study. The mean age at infection was higher in men (cohort mean 27·8-34·6 years) than in women (24·8-29·6 years). Between 2000 and 2017, the mean age at infection per cohort increased slightly: 0·5 to 2·8 years among men and -0·2 to 2·5 years among women. Across studies, between 38% and 63% (cohort medians) of the infections in women were among those aged 15-24 years and between 30% and 63% of infections in men were in those aged 20-29 years. Lifetime risk of HIV declined for successive birth cohorts. Interpretation: HIV incidence declined in all age groups and shifted slightly to older ages. Disproportionate new HIV infections occur among women aged 15-24 years and men aged 20-29 years, supporting focused prevention in these groups. However, 40-60% of infections were outside these ages, emphasising the importance of providing appropriate HIV prevention to adults of all ages. Funding: Bill & Melinda Gates Foundation. Competing Interests: Declaration of interests SG, MT, ES, and JWE report grants from the Gates Foundation. SG also reports grants from the Wellcome Trust, UK Medical Research Council/Department for International Development, US National Institutes of Health, and WHO, and dividends on ordinary shares in AstraZeneca and GlaxoSmithKline, outside of the submitted work. JWE also reports grants from the UNAIDS, US NIH, and WHO, and personal fees from WHO. LM reports grants from the London School of Hygiene & Tropical Medicine. All other authors declare no competing interests. (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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