The contribution of intimate partner violence to vertical HIV transmission: a modelling analysis of 46 African countries.

Autor:	Kuchukhidze S; Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada., Walters MK; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK., Panagiotoglou D; Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada., Boily MC; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK., Diabaté S; Département de Médecine Sociale et Préventive, Université Laval, Québec City, QC, Canada; Centre de Recherche du CHU de Québec-Université Laval, Québec City, QC, Canada., Russell WA; Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada., Stöckl H; Institute for Medical Information Processing, Biometry, and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany., Sardinha L; The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland., Mbofana F; Conselho Nacional de Combate ao HIV/Sida, Maputo, Mozambique., Wanyenze RK; Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda., Imai-Eaton JW; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Center for Infectious Disease Dynamics, Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA., Maheu-Giroux M; Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC, Canada. Electronic address: mathieu.maheu-giroux@mcgill.ca.
Jazyk:	angličtina
Zdroj:	The lancet. HIV [Lancet HIV] 2024 Aug; Vol. 11 (8), pp. e542-e551. Date of Electronic Publication: 2024 Jul 23.
DOI:	10.1016/S2352-3018(24)00148-6
Abstrakt:	Background: Addressing gender inequities could be key to the elimination of vertical transmission of HIV. Women experiencing intimate partner violence (IPV) might be at an increased risk of vertical transmission due to their vulnerability to HIV acquisition and barriers to access to and retention in care. Sub-Saharan Africa, where IPV burden is among the highest globally, accounts for most new paediatric HIV infections. We aimed to examine the proportion of excess vertical transmission attributable to IPV in this region. Methods: In this modelling analysis, we created a probability tree model of vertical HIV transmission among women aged 15-49 years in 46 African countries. We estimated the proportion of vertical transmission attributable to past-year physical or sexual IPV, or both, as an age-standardised population attributable fraction (PAF) and as excess vertical transmission risk per 1000 births among women experiencing IPV. We incorporated perinatal and postnatal vertical transmission among women who acquired HIV before pregnancy, during pregnancy, and during breastfeeding. Fertility, HIV prevalence, HIV incidence, antiretroviral therapy (ART) uptake, and ART retention varied in the model by women's IPV experience. The model was parameterised using UNAIDS' 2023 Spectrum model data, WHO's Global Database on Violence Against Women, and the peer-reviewed literature. Uncertainty intervals (95% UI) were calculated through 1000 Monte Carlo simulations. Findings: Across 46 countries 13% (95% UI 6-21) of paediatric HIV infections in 2022 were attributed to IPV, corresponding to over 22 000 paediatric infections. The PAF ranged from 4% (2-7) in Niger to 28% (13-43) in Uganda. The PAF was highest among girls aged 15-19 years (20%, 8-33) and lowest among women aged 45-49 years (6%, 3-9). In southern Africa, where women's HIV prevalence is highest (23%), IPV led to 11 (5-20) additional infections per 1000 births among women affected by IPV. Interpretation: IPV might be responsible for one in eight paediatric HIV infections in sub-Saharan Africa. Ending IPV could accelerate vertical transmission elimination, especially among young women who bear the highest burden of violence. Funding: Canadian Institutes of Health Research, Canada Research Chair, and Fonds de recherche du Québec-Santé. Translations: For the French, Georgian and Spanish translations of the abstract see Supplementary Materials section. Competing Interests: Declaration of interests MM-G reports contractual arrangements from WHO and UNAIDS, and support for their research programme by a Canada Research Chair (Tier 2) in Population Health Modeling. JWE-I reports research grants from the Bill & Melinda Gates Foundation, the US National Institutes of Health (NIH), UNAIDS, WHO, and the United States Agency for International Development, personal fees from Oxford Policy Management, and support for meeting travel from UNAIDS, BAO Systems, International AIDS Society, and SACEMA, all outside the submitted work. JWE-I and MKW acknowledge funding from National Institute of Allergy and Infectious Diseases of the NIH under award number 1R01AI152721-01A1, and the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement. The centre is also part of the EDCTP2 programme supported by the EU. M-CB declares funding from The HIV Prevention Trials Network (HPTN) Modelling Centre, which is funded by the NIH (grant number NIH UM1 AI068617) through HPTN, and funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/X020258/1), funded by the UK MRC; this UK funded award is carried out in the frame of the Global Health EDCTP3 Joint Undertaking. M-CB and MM-G acknowledge funding from the Wellcome Trust (grant number WT 226619/Z/22/Z). SK reports contractual arrangements from UNAIDS and is supported by a doctoral award from the Fonds de recherche du Québec-Santé. SD reports a grant from the Canadian Institutes of Health Research, outside the submitted work. WAR reports funding from Canadian Blood Services, Fonds de recherche du Québec, the Association for the Advancement of Blood and Biotherapies Foundation, Canadian Institutes of Health Research, Urgencé Santé, and Natural Sciences and Engineering Research Council of Canada, all outside the submitted work. All other authors declare no competing interests. (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu