HIV prevention

Published on September 15, 2015 by

HIV testing in South Africa: successes and challenges

HIV testing is critically important to HIV prevention and treatment. Therefore UNAIDS has called for 90% of all HIV-positive individuals to be diagnosed by 2020. However, there are practical challenges associated with measuring progress towards this target. Many countries simply quote the proportion of adults who report having ever been tested for HIV in national household surveys. In a recent study, we attempted to obtain more accurate estimates of rates of HIV testing in South Africa, by combining survey data and routine testing data from health services. The results suggest that there is likely to be significant bias in self-reporting of past HIV testing. The results also show that South Africa has made substantial progress in scaling up access to HIV testing and counselling, with 76% of HIV-positive adults diagnosed by 2012. However, men and older adults appear to have a relatively low rate of HIV testing.

Published on June 18, 2015 by

Is the HIV vaccine our best shot? – Why the answer to HIV prevention will be found in South Africa

South Africa is the unenviable epicentre of the HIV pandemic with 0.7% of the global population sadly amassing 18% of the global prevalence. The government has expanded interventions over the years to quell the epidemic. Sadly however, 58% of South Africans eligible for ARV treatment remain unable to access it. Despite the strides made by government to alleviate the HIV burden, high HIV incidence rates of 16% were reported in 2013. We can gauge from this that the current prevention and treatment processes are failing. The question is: what alternatives do we have at our disposal? And could we gauge the potential success of these?

Short item Published on March 17, 2015

Characterizing concurrent partnerships in Cape Town

Concurrent partnerships have been suggested as a possible driver of the HIV epidemic in Southern Africa. To date, estimates of concurrency in published literature have been problematic due to poor definitions and measurement. We conducted a sexual behaviour survey in Cape Town that characterized concurrency by estimating the point prevalence, cumulative prevalence, incidence and degree distribution of concurrent partnerships. We also described the duration of overlaps for relationships begun in the previous year and the relative risk of having concurrent partnerships for different race and sex groups.

Published on June 17, 2014 by

Pre-exposure prophylaxis and antiretroviral therapy for HIV prevention in South Africa – which is the best use of resources?

In recent years, scientific innovations in HIV control have expanded the range of available interventions – male circumcision, topical microbicides, oral pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) have all sparked significant interest due to their potential effectiveness and versatility. While all these options are potentially available, resources remain limited and choosing which interventions to implement at scale is a difficult task, given the complex nature of disease transmission, the impact of behaviour in epidemic dynamics, and the different costs of these programs. Here we analyse the effects of scaling up PrEP and ART for HIV prevention in South Africa, to help decision makers understand how these interventions would work if considered independently or in combination.

Published on March 13, 2014 by

Preventing HIV transmission – a new argument for tracing patients lost to follow-up?

Loss to follow-up (LTFU) is a serious problem in most sub-Saharan African ART programmes. If ART is interrupted or reduced, HIV again progresses, and this increases the risk of opportunistic infections and, ultimately, AIDS and death. In addition, the viral load of a patient who interrupts ART will rebound, and the probability of onward transmission increases. If tracing programmes can accelerate the return of lost patients, these patients may be less likely to transmit the virus, since the period of lapsed treatment is shortened. In this study, we created a mathematical model to determine whether tracing patients LTFU from ART programs would lower the rate of HIV transmission.

Short item Published on March 13, 2014

Relationships with Young Men and Age-Mates are Considered ‘Risky’ by Women in Cape Town

Young women in relationships with older men are typically at an elevated risk for acquisition of HIV in sub-Saharan Africa. Most qualitative studies have tended to focus on why women are motivated to participate in these relationships, offering little insight into perceived risks of these relationships. Therefore we conducted a qualitative study in three urban communities in Cape Town using thematic content analysis to explore women’s perceived risks of (non-)age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around these relationships.

Published on September 13, 2013 by

A journey to show the benefits of early antiretroviral therapy initiation in Viet Nam

My motivation to plan for the mathematical modelling of the HIV epidemic in Viet Nam has been to demonstrate the benefits of earlier initiation of antiretroviral treatment (ART). I especially wanted to estimate the potential impact of ART to prevent HIV transmission in communities. I hoped that the results would potentially influence the society to become more serious in creating an environment in which people feel safe to access HIV testing and counselling and treatment early, especially for the people who inject drugs and other groups who have a high HIV incidence. Here I tell you my journey to realize my plan.

Short item Published on March 18, 2013

Video: Brian Williams addresses U.S. Senators, Congress Members and Staff on Test-and-Treat

On June 19, 2012, SACEMA’s Brian Williams, also Senior Technical Adviser to Test & Treat to End AIDS, held a briefing in Washington DC in which he explained to US senators, members of congress, and staff how this strategy has the potential to stop the spread of HIV/AIDS and, over time, to save billions of Read More

Published on September 12, 2012 by

Can regular measurements of HIV concentration in blood during antiretroviral therapy prevent transmission?

A recent randomized controlled trial demonstrated that antiretroviral therapy (ART) prevents HIV transmission. In successfully treated patients the HI virus in the blood is suppressed to undetectable levels and therefore the probability of transmitting the virus is extremely low. This new finding must be incorporated into the evaluation of the advantages and disadvantages of different ART provision strategies. The optimal strategy for monitoring treatment response and detecting treatment failure – routine viral load monitoring (rVL) or CD4 cell counts or clinical symptoms – has been the subject of continuous debate. We suspected that rVL could potentially prevent HIV transmission by making it easier to detect treatment failure earlier. We developed a mathematical simulation model to estimate potential transmission from 1,000 patients treated with ART with either rVL or CD4 monitoring.

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