Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data
Summary Background The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to...
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| Veröffentlicht in: | The Lancet (British edition) 2013-05, Vol.381 (9877), p.1561-1569 |
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| creator | Bellan, Steve E, Dr Fiorella, Kathryn J, AB Melesse, Dessalegn Y, MSc Getz, Wayne M, Prof Williams, Brian G, PhD Dushoff, Jonathan, Prof |
| description | Summary Background The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts. Methods We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003–2011, of 27 201 cohabiting couples (men aged 15–59 years and women aged 15–49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse. Findings In surveyed couples, we estimated that extra-couple transmission accounted for 27–61% of all HIV infections in men and 21–51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32–65% of new incident HIV infections in men in cohabiting couples, and 10–47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation. Interpretation Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples. Funding US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation. |
| doi_str_mv | 10.1016/S0140-6736(12)61960-6 |
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We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts. Methods We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003–2011, of 27 201 cohabiting couples (men aged 15–59 years and women aged 15–49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse. Findings In surveyed couples, we estimated that extra-couple transmission accounted for 27–61% of all HIV infections in men and 21–51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32–65% of new incident HIV infections in men in cohabiting couples, and 10–47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation. Interpretation Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples. Funding US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(12)61960-6</identifier><identifier>PMID: 23391466</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Africa South of the Sahara - epidemiology ; Age ; Antiretroviral agents ; Biological and medical sciences ; Confidence intervals ; Couples ; Disease transmission ; Estimates ; Family Characteristics ; Female ; General aspects ; Health Surveys ; HIV ; HIV infections ; HIV Infections - epidemiology ; HIV Infections - transmission ; HIV Seropositivity - epidemiology ; HIV Seropositivity - transmission ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infections ; Infectious diseases ; Internal Medicine ; Male ; Mathematical models ; Medical sciences ; Men ; Middle Aged ; Models, Biological ; National Institutes of Health ; Polygamy ; Prevention ; Sexually transmitted diseases ; STD ; surveys ; therapeutics ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; women ; Young Adult</subject><ispartof>The Lancet (British edition), 2013-05, Vol.381 (9877), p.1561-1569</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited May 4, 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c582t-46bee75c392d4d64570d9ad1a05d5e8fa752e32b18834519e54d8d33539391b43</citedby><cites>FETCH-LOGICAL-c582t-46bee75c392d4d64570d9ad1a05d5e8fa752e32b18834519e54d8d33539391b43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1351928550?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27282198$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23391466$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bellan, Steve E, Dr</creatorcontrib><creatorcontrib>Fiorella, Kathryn J, AB</creatorcontrib><creatorcontrib>Melesse, Dessalegn Y, MSc</creatorcontrib><creatorcontrib>Getz, Wayne M, Prof</creatorcontrib><creatorcontrib>Williams, Brian G, PhD</creatorcontrib><creatorcontrib>Dushoff, Jonathan, Prof</creatorcontrib><title>Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts. Methods We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003–2011, of 27 201 cohabiting couples (men aged 15–59 years and women aged 15–49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse. Findings In surveyed couples, we estimated that extra-couple transmission accounted for 27–61% of all HIV infections in men and 21–51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32–65% of new incident HIV infections in men in cohabiting couples, and 10–47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation. Interpretation Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples. Funding US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Africa South of the Sahara - epidemiology</subject><subject>Age</subject><subject>Antiretroviral agents</subject><subject>Biological and medical sciences</subject><subject>Confidence intervals</subject><subject>Couples</subject><subject>Disease transmission</subject><subject>Estimates</subject><subject>Family Characteristics</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Surveys</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - transmission</subject><subject>HIV Seropositivity - epidemiology</subject><subject>HIV Seropositivity - transmission</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Immunodeficiencies</subject><subject>Immunodeficiencies. Immunoglobulinopathies</subject><subject>Immunopathology</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medical sciences</subject><subject>Men</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>National Institutes of Health</subject><subject>Polygamy</subject><subject>Prevention</subject><subject>Sexually transmitted diseases</subject><subject>STD</subject><subject>surveys</subject><subject>therapeutics</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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Immunoglobulinopathies</topic><topic>Immunopathology</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Mathematical models</topic><topic>Medical sciences</topic><topic>Men</topic><topic>Middle Aged</topic><topic>Models, Biological</topic><topic>National Institutes of Health</topic><topic>Polygamy</topic><topic>Prevention</topic><topic>Sexually transmitted diseases</topic><topic>STD</topic><topic>surveys</topic><topic>therapeutics</topic><topic>Viral diseases</topic><topic>Viral diseases of the lymphoid tissue and the blood. 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Dr</au><au>Fiorella, Kathryn J, AB</au><au>Melesse, Dessalegn Y, MSc</au><au>Getz, Wayne M, Prof</au><au>Williams, Brian G, PhD</au><au>Dushoff, Jonathan, Prof</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2013-05-04</date><risdate>2013</risdate><volume>381</volume><issue>9877</issue><spage>1561</spage><epage>1569</epage><pages>1561-1569</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background The proportion of heterosexual HIV transmission in sub-Saharan Africa that occurs within cohabiting partnerships, compared with that in single people or extra-couple relationships, is widely debated. We estimated the proportional contribution of different routes of transmission to new HIV infections. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is crucial to target intervention efforts. Methods We built a mechanistic model of HIV transmission with data from Demographic and Health Surveys (DHS) for 2003–2011, of 27 201 cohabiting couples (men aged 15–59 years and women aged 15–49 years) from 18 sub-Saharan African countries with information about relationship duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and coverage of antiretroviral therapy (ART). We then estimated the proportion of recorded infections in surveyed cohabiting couples that occurred before couple formation, between couple members, and because of extra-couple intercourse. Findings In surveyed couples, we estimated that extra-couple transmission accounted for 27–61% of all HIV infections in men and 21–51% of all those in women, with ranges showing intercountry variation. We estimated that in 2011, extra-couple transmission accounted for 32–65% of new incident HIV infections in men in cohabiting couples, and 10–47% of new infections in women in such couples. Our findings suggest that transmission within couples occurs largely from men to women; however, the latter sex have a very high-risk period before couple formation. Interpretation Because of the large contribution of extra-couple transmission to new HIV infections, interventions for HIV prevention should target the general sexually active population and not only serodiscordant couples. Funding US National Institutes of Health, US National Science Foundation, and J S McDonnell Foundation.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>23391466</pmid><doi>10.1016/S0140-6736(12)61960-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The Lancet (British edition), 2013-05, Vol.381 (9877), p.1561-1569 |
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| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Adolescent Adult Africa South of the Sahara - epidemiology Age Antiretroviral agents Biological and medical sciences Confidence intervals Couples Disease transmission Estimates Family Characteristics Female General aspects Health Surveys HIV HIV infections HIV Infections - epidemiology HIV Infections - transmission HIV Seropositivity - epidemiology HIV Seropositivity - transmission Human immunodeficiency virus Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infections Infectious diseases Internal Medicine Male Mathematical models Medical sciences Men Middle Aged Models, Biological National Institutes of Health Polygamy Prevention Sexually transmitted diseases STD surveys therapeutics Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids women Young Adult |
| title | Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data |
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