Ongoing High HIV Incidence among Women and Men in Chókwè ...

Ongoing High HIV Incidence among Women and Men in Chókwè ...

Ongoing High HIV Incidence among Women and Men in Chkw, Southern Mozambique: A Call for Rapid Scale-up of Combination HIV Prevention Robert Nelson1, Ricardo Thompson2, Isabelle Casavant3, Sherri Pals1, Juvencio Bonzela2, Didier Mugabe2, Jos Come2, Dawud Ujamaa1, Judite Cardoso4, Andrew Auld1, Bertur Maculuve5, Stan Wei3, Daniel Shodell6, Duncan MacKellar1 Centers for Disease Control and Prevention, Atlanta, Georgia, USA Chkw Health Research and Training Center (CITSC), National Institute of Health, Mozambique 3 Centers for Disease Control and Prevention, Maputo, Mozambique 4 Jhpiego, Maputo, Mozambique 5 Public Health Department Gaza, Xaixai, Mozambique 6 Colorado Department of Public Health and Environment, Denver, Colorado, USA 1 2 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. #AIDS2016 | @AIDS_conference Background UNAIDS estimates that over 1.5 million Mozambicans are infected with HIV

Highest burden is in southern Mozambique, with community prevalence as high as 40% 1 A 2012 cohort study of sexually active women 18-35 years of age in Chokwe District found incidence of 4.6 (95% CI: 2.7-7.3) per 100 PY 2 HIV incidence is high in regions of South Africa close to Mozambique, with location-specific incidence as high as 14.8 (95% CI: 9.7-19.8) per 100 PY 3 In 2014, the Chkw Health Demographic Surveillance System (CHDSS) incorporated HIV testing and counseling (HTC) within annual rounds of demographic surveillance In this presentation, we report HIV prevalence, prior diagnosis, ART coverage from the first round and incidence during the first two rounds Gonzalez, et al. (2012). High HIV prevalence in a southern semi rural area of Mozambique rural area of Mozambique HIV medicine. Feldblum, et al. (2014). HIV prevalence and incidence in a cohort of women PLoS One 3 Nel, et al. (2012). HIV incidence remains high in KwaZulu-Natal, South Africa... PLoS One 4 Casavant et al. (2016). Home-based HIV Testing and New HIV Diagnoses CROI 2016. 1 2 #AIDS2016 | @AIDS_conference Overarching Project Objectives Move toward 90-90-90 by increasing HIV testing and ART coverage Assess trends in the uptake of evidence-based interventions, community viral load, and HIV

prevalence and incidence Assess individual factors associated with the uptake of evidence-based interventions and HIV infection #AIDS2016 | @AIDS_conference Methods Annual HDSS census of approximately 95,000 residents in Chkw town and 6 neighboring villages ~50,000 residents 15-59 years of age, our study population #AIDS2016 | @AIDS_conference Methods - Evaluation Design Summary HDSS Census Updates Ongoing Round 2 Round 1 Round 4 Round 3 Dec 2015 May 2016 April 2014 May 2015 May 2015 Dec 2016 March 2017 Dec 2017 HTC & Brief Survey 100% HHs HTC & Brief

Survey 100% HHs HTC & Brief Survey 100% HHs HIV Prev. Survey (10% HIV Prev. Survey (10% HIV Prev. Survey (10% HH Sample) HH Sample) HH Sample) HIV+ Followup & Referral to Care HIV+ Followup & Referral to Care

#AIDS2016 | @AIDS_conference HIV+ Followup & Referral to Care HTC & Brief Survey 100% HHs HIV Prev. Survey (10% HH Sample) HIV+ Followup & Referral to Care Round 1 Testing and HIV Prevalence 25,435 residents 15-59 years of age tested 7959 (31%) men 17476 (69%) women 9942 (39%) 15-24 years of age 10,666 (42%) 25-44 years of age 4789 (19%) 45-59 years of age 5,170 (20%) Tested HIV+ 994 (13%) of men tested HIV+ 4176 (24%) of women tested HIV+

1947 (38%) newly diagnosed with HIV 471 (47%) among men 1476 (35%) among women #AIDS2016 | @AIDS_conference Round 1 prevalence of HIV infection and percentage of new HIV diagnoses, by age-group and sex 40 35 Percentage 30 25 20 15 10 5 0 New HIV DX #AIDS2016 | @AIDS_conference Prior HIV DX

Pad ART Coverage Abstract WEPEC173 addresses ART coverage Patient-reported ART uptake was confirmed in 95% of cases by observing ART pill bottles Among HIV positive participants, 3,179 (62%) had been previously diagnosed, 3,092 (60%) were ever in HIV care, 2,946 (58%) received HIV care within 90 days, and 2,587 (51%) were on ART ART eligibility at the time of the study was CD4 350 or WHO stage III/IV #AIDS2016 | @AIDS_conference % Reporting Service Uptake Percentage of HIV positive round 1 participants already diagnosed and currently on ART by age-group and sex 80% 73% 73% 72% 70%

62% Prior HIV Diagnosis 60% Currently on ART 62% 54% 49% 50% 44% 40% 40% 35% 30% 20% 30% 26%

20% 10% 0% #AIDS2016 | @AIDS_conference 28% 62% 60% Incidence 15,933 round 1 participants enrolled in round 2 11,822 were HIV negative in round 1 and tested again (58% of round 1 HIV negative) 550 tested HIV positive in round 2 Incidence analysis is restricted to residents who tested HIV-negative in round 1 and retested in round 2 Adjusted incidence rates (IR) per 100 person-years were estimated with a generalized linear model using SAS 9.4 #AIDS2016 | @AIDS_conference Adjusted HIV Incidence and 95% Confidence Intervals, Total and by Residence Demographic

Group Total Chkw Town Villages Participants Incident Infections 11822 550 7345 385 4477 165 Follow-up Crude IR per Person Years 100 Person Years 8826.1 6.2 (5.7-6.8) 5115.4 7.5 (6.8-8.3) 3710.7 4.4 (3.8-5.1)

Adjusted IR per 100 Persons Years 5.0 (4.4-5.7) 6.7 (5.8-7.6) 3.7 (3.1-4.5) Adjusted HIV Incidence and 95% Confidence Intervals, by Sex and Age-group 14 Incidence Rate per 100 PY 12.5 12 Women Men 10 8.3 8 7.1 6

5.1 4.1 4 2 1 0 15-24 #AIDS2016 | @AIDS_conference 25-44 45-54 Limitations Findings are preliminary. Round 2 data are still being validated and cleaned Results were not weighted to account for underlying HDSS demographic distribution Findings may be subject to bias of unknown magnitude and direction Approximately half of HDSS residents tested in round 1

Only 60% of HIV-negative participants re-tested in round 2 Men were under-represented in both rounds #AIDS2016 | @AIDS_conference Conclusion HIV incidence is exceptionally high among residents aged 25-44 years in Chkw District. Among persons under 25 years, HIV incidence is higher in women than men; among persons older than 25, incidence is higher in men ART coverage in round 1 was low, at 51%. Coverage by age-group and sex was lowest at 20% among men ages 15-24 To reduce HIV incidence, combined evidence-based HIV prevention interventions such as HIV testing and linkage to care, antiretroviral treatment as prevention, and male circumcision should be scaled up in Chkw District The district has been selected by the Ministry of Health to pilot test-and-start beginning in 2016 The Chokwe HDSS is well positioned to measure the impact of these

interventions #AIDS2016 | @AIDS_conference Acknowledgements CITSC Ricardo Thompson Juvencio Bonzela Didier Mugabe Jose Come Salvador Machava Jhpiego/Anglican Church Judite Cardoso Argentina Balate Alegria Bendzane CDC-Mozambique Provincial Public Health Alfredo Vergara Directorate Edgar Monterroso Isaias Ramiro Stan Wei Bertur Alface Isabelle Casavant Braiton Maculuve Daniel Shodell Nick Schaad

Peter Young CDC-Atlanta Duncan MacKellar Irene Benech Jan Moore Robert Nelson Andrew Auld Ishani Pathmanathan Laura Broyles Sherri Pals Bharat Parekh Chunfu Yang Susan Nkengasong Eduardo Valverde This research has been supported by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention under the terms of GH11-1158 and PS09-905. #AIDS2016 | @AIDS_conference Contact [email protected] #AIDS2016 | @AIDS_conference

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