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. 2013 Nov 13;27(17):2765-73.
doi: 10.1097/01.aids.0000432454.68357.6a.

Assessing the effect of HIV counselling and testing on HIV acquisition among South African youth

Nora E Rosenberg  1 , Daniel Westreich, Till Bärnighausen, William C Miller, Frieda Behets, Suzanne Maman, Marie-Louise Newell, Audrey Pettifor
Affiliations

Assessing the effect of HIV counselling and testing on HIV acquisition among South African youth

Nora E Rosenberg et al. AIDS. .

Abstract

Objective: Youth aged 15-24 years in sub-Saharan Africa are at a high risk for HIV acquisition and urgently need HIV prevention interventions. HIV counselling and testing (HCT) is designed to promote HIV prevention. However the impact of HCT on HIV acquisition has never been assessed among youth. We assess the impact of HCT on HIV acquisition among South African youth.

Design: Data came from an annual HIV survey for persons aged 15 years and over, nested within a socio-demographic household surveillance in a geographically defined area of KwaZulu-Natal. Within this population, we used data from 2006 to 2011 to construct a cohort of HIV-uninfected youth aged 15-24 years.

Methods: We compared youth who reported knowing their HIV status from HCT with those who reported not knowing their HIV status for time to HIV seroconversion using time-varying marginal structural Cox proportional hazards models.

Results: The cohort included 3959 HIV-uninfected youth, of whom 1167 (29%) reported HCT at baseline and an additional 1064 (27%) reported HCT during follow up. Youth experienced 248 seroconversions over 8536 person-years, an incidence rate of 2.91 per 100 person-years [95% confidence interval (CI) 2.56-3.28]. In crude analysis, HCT was not associated with HIV incidence (hazard ratio 1.02, 95% CI 0.79-1.31], but in marginal structural models weighted for risk factors, HCT was protective (hazard ratio 0.59, 95% CI 0.45-0.78).

Conclusion: In this high-risk population, after accounting for differences in underlying HIV acquisition risk, HCT was associated with lower HIV incidence. HCT scale-up may have prevention benefits for HIV-uninfected youth.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

Figure 1
Figure 1. Study Population
Figure 1 illustrates the number of youth 15–24 in the catchment area with at least two surveillance time points from 2006–2010. It shows the proportion included and excluded from the analysis, and the proportion who experienced HCT initially and over time.
Figure 2
Figure 2. HIV-free Survival by HIV Counseling and Testing Status: Unweighted and Inverse Probability Weighted Curves
Figure 2 depicts the unweighted and weighted Kaplan Meier survival curves comparing those who were HCT-unexposed to those who were HCT-exposed. The inverse probability weighted graph is constructed in a population with time divided into person-months.
See this image and copyright information in PMC

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References

    1. UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic. 2010
    1. Pettifor AE, Rees HV, Kleinschmidt I, Steffenson AE, MacPhail C, Hlongwa-Madikizela L, et al. Young people's sexual health in South Africa: HIV prevalence and sexual behaviors from a nationally representative household survey. AIDS. 2005;19:1525–1534. - PubMed
    1. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Pillay-van Wyk V, et al. South African national HIV prevalence, incidence, behavior and communication survey 2008: a turning tide among teenagers? Cape Town. 2009
    1. Matovu JK, Gray RH, Makumbi F, Wawer MJ, Serwadda D, Kigozi G, et al. Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda. AIDS. 2005;19:503–511. - PubMed
    1. Corbett EL, Makamure B, Cheung YB, Dauya E, Matambo R, Bandason T, et al. HIV incidence during a cluster-randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe. AIDS. 2007;21:483–489. - PubMed

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