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

BMC Public Health

Study Protocol

Adrian Puren¹  Janet A Frohlich²  Ayesha BM Kharsany²  Anneke Grobler²  Natasha Samsunder²  Quarraisha Abdool Karim²  Lyle R. Mckinnon²  Carlos Toledo³  Mary T Glenshaw⁴  Alfred Bere⁴  Varough M Deyde⁴  Zawadi Chipeta⁴  Lycias Zembe⁴  Cherie Cawood⁵  David Khanyile⁵  Lorna Madurai⁶  Gavin George⁷  Kaymarlin Govender⁷  Alex Welte⁸ 

[1] Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa;Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Private Bag 7, 4013, Congella, Durban, South Africa;Centres for Disease Control and Prevention (CDC) Atlanta, Atlanta, USA;Centres for Disease Control and Prevention (CDC), Pretoria, South Africa;Epicentre AIDs Risk Management (Pty) Limited, P O Box 3484, 7620, Paarl, Cape Town, South Africa;Global Clinical and Virology Laboratory, 11 Dan Pienaar Place, Amanzimtoti, South Africa;Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa;South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa;

关键词: Sexually Transmit Infection;    Voluntary Medical Male Circumcision;    Primary Health Care Clinic;    Enumeration Area;   

DOI  :  10.1186/s12889-015-2179-2

 received in 2015-07-20, accepted in 2015-08-21,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Kharsany et al. 2015