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HIV Prevalence and Incidence Estimates Among Women with High Risk Indicators in Addis Ababa, Ethiopia. Asfawesen G-Yohanes 1 , Stephanie Combes 2, Abraham Aseffa 1 , Pai -Lien Chen 2 , Paul Feldblum 2 , Shelly Fischer 2 Dominick Shattuck 2 , Altaye Kidane 2

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Overview

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  1. HIV Prevalence and Incidence Estimates Among Women with High Risk Indicators in Addis Ababa, Ethiopia Asfawesen G-Yohanes1 , Stephanie Combes2, Abraham Aseffa1 , Pai-Lien Chen2, Paul Feldblum2 , Shelly Fischer2 Dominick Shattuck2 , Altaye Kidane2 Armauer Hansen Research Institute, ALERT Center, Addis Ababa, Ethiopia Family Health International 360, Durham, United States Family Health International 360, Addis Ababa, Ethiopia

  2. Overview • The need for clinical trial sites for HIV prevention research • Criteria for successful development • Collaboration in Ethiopia • Cross-sectional HIV incidence study in Addis Ababa • Parallel BED False Recent study

  3. Introduction: Need for HIV Prevention Clinical Trial Sites • Promising results from HIV prevention trials • Male circumcision • Topical microbicide, Tenofovir gel • Oral pre-exposure prophylaxis • Continuing need for new clinical trial sites • USAID and FHI360 project to develop trial sites • Site Identification and Development Initiative (SIDI)

  4. Dimensions of successful capacity building • Trained staff • Clinical infrastructure • Laboratory infrastructure • Data management capacity • Supportive administration • HIV prevention as part of government priorities

  5. FHI 360 and AHRI collaboration • Armauer Hansen Research Institute (AHRI) is the research arm of ALERT Center • Has MOH support for conducting research • FHI360 & AHRI worked together to increase the clinical trial capacity at AHRI • Hired & trained staff • Increased laboratory and data management capacity • Conducted a GCP compliant HIV Incidence study

  6. Cross-sectional HIV Incidence Study • Recruited women at higher risk of HIV infection using modified Respondent Driven sampling method • Eligibility criteria: • 18 – 35 years old • >2 heterosexual sex acts per week and/or • > 2 partners in the previous one month • Data collected: • Baseline demographics • Medical history • Sexual behaviors • HIV and pregnancy testing • Syndromic STI treatment provided, if indicated • Estimated incidence ( Recent Infection) using BED-CEIA assay

  7. Parallel BED False Recent Study • BED-CEIA assay tends to overestimate the number of incident infections • Need to measure the local false recent rate (correction factor) • Enrolled women and men who: • Ages 18-35 • Documented as HIV-positive for at least 12 months • No history of ART (including Nevirapin) • BED testing to find proportion who falsely show as recently infected

  8. Results - Enrollment • 1865 women enrolled in cross-sectional phase • 1855 underwent HIV testingusing parallel rapid testing • HIV positive samples tested with the BED assay • 574 enrolled in BED false recent phase • 504 women with 431 tested • 70 men with 55 tested

  9. Cross-sectional Phase Demographics

  10. Region of Birth

  11. Cross-sectional: High Risk Behavior & FP • 94% of participants had >5 partners in the last month • 2.5% had sex with an HIV infected partner in the last month • Some form of contraception used by 90% of women • 35% used condoms only • 42% used injectables • 14% used pills

  12. Pregnancy • Prevalence of 5.9% • Higher occurrence of pregnancies among • Condom users (9.5%) • Pill users (3.7%)

  13. HIV Prevalence • Prevalence: 11.3% • Higher prevalence among older women (aged > 25 years) • 26.5% vs 7.9%

  14. Predictors of HIV prevalence • In logistic regression analysis, 3 indicators were most predictive of HIV prevalence: • Being older (> 25 years old): OR = 4.4 • Presence of STI symptoms: OR = 2.4 • Having unprotected sex (no condom) in previous 7 days: OR = 1.5

  15. HIV Incidence • Adjusted incidence: 2.7% [1.7% - 3.6%] • Incidence by age group is similar • 18-24 Yrs: 2.5% • 25-35 Yrs: 3.0%

  16. Conclusions • One of first studies in Ethiopia to specifically measure HIV incidence • Incidence is high enough to justify HIV prevention trials • Age, STI symptoms, & recent unprotected sex are greatest risk factors for prevalent infections • Family planning is another reproductive health need • Large sub-group of women at higher risk of HIV in this section of Addis • AHRI well placed for future prevention research & programming

  17. Acknowledgements • SIDI Team at AHRI • Addis Ababa City Admin Health Bureau • KolfeKeranyoSubcity Administration, Wereda and Kebele Offices • ALERT, Zwditu M, St Paul and Yekatit 12 Hospitals • Wereda 23, 24, 25 Health Centers • HAPCSO • FHI360-NC: Connie Sexton** • FHI 360-Ethiopia: Francesca Stuer

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