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Trends in HIV prevalence and HIV incidence in South Africa

Trends in HIV prevalence and HIV incidence in South Africa. Thomas M. Rehle, MD, PhD Human Sciences Research Council (HSRC) Cape Town, South Africa AIDS 2014 Melbourne, Australia. National HIV Household Surveys South Africa. Main survey objectives:

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Trends in HIV prevalence and HIV incidence in South Africa

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  1. Trends in HIV prevalence and HIV incidence in South Africa Thomas M. Rehle, MD, PhD Human Sciences Research Council (HSRC) Cape Town, South Africa AIDS 2014 Melbourne, Australia

  2. National HIV Household SurveysSouth Africa • Main survey objectives: - to obtain national, representative data for the entire population - to estimate HIV prevalence & HIV incidence - to measure behavioral / socio-demographic and health indicators • Reporting domains: Age Sex Race Locality type (urban formal, urban informal, rural formal, rural informal) Province

  3. National HIV household surveysSouth Africa 2002, 2005, 2008, 2012 Multi-stage cluster sampling Linked anonymous HIV testing Study population: ≥ 2 years in 2002 & 2005; under 2 year olds included in 2008 & 2012 Specimens: 2002 oral; 2005, 2008, 2012 dried blood spot

  4. National HIV Household SurveySouth Africa 2012 • Survey period: January 2012 – November 2012 • 38,431 interviewed • 28,997 tested for HIV

  5. Laboratory Testing Dried Blood Spot HIV Ab screening PCR (infants) Ab Pos HIV Incidence Testing (> 2 years) Antiretrovirals ARVs

  6. Hiv prevalence

  7. P = I*D …If it was so easy New infections Prevalence Deaths

  8. National HIV Household SurveySouth Africa 2012 • HIV prevalence, total population: 12.2% (2008: 10.6%) • 6.4 million living with HIV/AIDS

  9. HIV prevalence by age and sex, South Africa, 2012

  10. HIV prevalence by sex (15-49 years), South Africa, 2012

  11. Trends in HIV prevalence in children, South Africa 2002-2012

  12. Trends in HIV prevalence by age, South Africa 2002-2012

  13. HIV prevalence among females, South Africa 2008 and 2012

  14. Antiretroviral Treatment (ART) Exposure

  15. → need to test for ARVs in HIV surveys!ART rollout in South Africa(L. Johnson, SAJHIVMED 2012)

  16. Testing for ARVs • Method: High Performance Liquid Chromatography coupled to Tandem Mass Spectrometry (HPLC – MS/MS) • Qualitative determination of ARVs (NRTI, NNRTI and PI) in HIV positive DBS samples: 2012: Zidovudine, Nevirapine, Efavirenz, Lopinavir, Atazanavir, Darunavir

  17. ART Exposure, South Africa mid-2012

  18. ART Exposure by Age Group, South Africa mid-2012

  19. Hiv Incidence ESTIMATION

  20. Measuring HIV Incidence South Africa 2012 • Direct HIV incidence using blood specimens - Multi - assay testing algorithm

  21. Recent Infection Detection Algorithm OUTCOME LAg-Avidity EIA Long-term Chronically infected subjects Recent ARV Testing Positive Chronically infected subjects receiving HAART Negative Viral Load <1000 copies/mL Chronically infected elite suppressor or subjects with low VL >1000 copies/mL Recently infected individuals

  22. Direct, assay-based HIV incidence rates by age and sex, South Africa 2012

  23. Direct, assay-based HIV incidence rates by behavioral and socio-demographic variables (15-49 years), South Africa 2012

  24. Measuring HIV Incidence South Africa 2002 - 2012 2. Indirect HIV incidence using a mathematical model - HIV incidence estimation from HIV prevalence data collected in repeated national population-based surveys (HSRC 2002, 2005, 2008 & 2012)

  25. First cross-sectional survey Second cross-sectional survey 25y 20y 15y Inter-survey period Age Time Not same individuals followed-up, but the two samples represent thesame population.

  26. Modeled HIV incidence rates by age, South Africa 2002-2005, 2005-2008 and 2008-2012

  27. Acknowledgements This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through CDC under the terms of 5U2GPS000570 and U2GPS001328.

  28. 1918 – 2013 THANK YOU

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