Strengthening HIV surveillance in the antiretroviral therapy era: rationale and design of a longitudinal study to monitor HIV prevalence and incidence in the uMgungundlovu District, KwaZulu-Natal, South AfricaReport as inadecuate




Strengthening HIV surveillance in the antiretroviral therapy era: rationale and design of a longitudinal study to monitor HIV prevalence and incidence in the uMgungundlovu District, KwaZulu-Natal, South Africa - Download this document for free, or read online. Document in PDF available to download.

BMC Public Health

, 15:1149

First Online: 20 November 2015Received: 20 July 2015Accepted: 21 August 2015DOI: 10.1186-s12889-015-2179-2

Cite this article as: Kharsany, A.B., Cawood, C., Khanyile, D. et al. BMC Public Health 2015 15: 1149. doi:10.1186-s12889-015-2179-2

Abstract

BackgroundSouth Africa has over 6,000,000 HIV infected individuals and the province of KwaZulu-Natal KZN is the most severely affected. As public health initiatives to better control the HIV epidemic are implemented, timely, detailed and robust surveillance data are needed to monitor, evaluate and inform the programmatic interventions and policies over time. We describe the rationale and design of the HIV Incidence Provincial Surveillance System HIPSS to monitor HIV prevalence and incidence.

Methods-DesignThe household-based survey will include a sample of men and women from two sub-districts of the uMgungundlovu municipality Vulindlela and the Greater Edendale of KZN, South Africa. The study is designed as two sequential cross-sectional surveys of 10,000 randomly selected individuals aged 15–49 years to be conducted one year apart. From the cross sectional surveys, two sequential cohorts of HIV negative individuals aged 15–35 years will be followed-up one year later to measure the primary outcome of HIV incidence. Secondary outcomes include the laboratory measurements for pulmonary tuberculosis, sexually transmitted infections and evaluating tests for estimating population-level HIV incidence.

Antiretroviral therapy ART access, HIV-1 RNA viral load, and CD4 cell counts in HIV positive individuals will assess the effectiveness of the HIV treatment cascade. Household and individual-level socio-demographic characteristics, exposure to HIV programmatic interventions and risk behaviours will be assessed as predictors of HIV incidence. The incidence rate ratio of the two cohorts will be calculated to quantify the change in HIV incidence between consecutive samples. In anticipation of better availability of population-level HIV prevention and treatment programmes leading to decreases in HIV incidence, the sample size provides 84 % power to detect a reduction of 30 % in the HIV incidence rate between surveys.

DiscussionThe results from HIPSS will provide critical data regarding HIV prevalence and incidence in this community and will establish whether HIV prevention and treatment efforts in a -real world-, non-trial setting have an impact on HIV incidence at a population level. Importantly, the study design and methods will inform future methods for HIV surveillance.

AbbreviationsARTAntiretroviral therapy

BRECBiomedical Research Ethics Committee

CABCommunity Advisory Board

CCTConditional cash transfers

CIConfidence interval

DOHDepartment of Health

DREAMSDetermined, Resilient, AIDS-free, Mentored, and Safe project

EAEnumeration areas

GTIGeo Terra Image

HCTHIV counselling and testing

HTAHigh transmission areas

KZNKwaZulu-Natal

PEPFARThe United States President’s Emergency Plan for AIDS Relief

PDAPersonal digital assistant

PHCPrimary health care

PMTCTPrevention of mother-to-child transmission

UNAIDSThe Joint United Nations Programme on HIV-AIDS

VMMCVoluntary medical male circumcision

Download fulltext PDF



Author: Ayesha BM Kharsany - Cherie Cawood - David Khanyile - Anneke Grobler - Lyle R. Mckinnon - Natasha Samsunder - Janet A Fr

Source: https://link.springer.com/







Related documents