The risk of HIV transmission within HIV-1 sero-discordant couples appears to vary across sub-saharan africa

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Abstract

Background: Representative and precise estimates for the annual risk of HIV transmission (φ) from the infected to the uninfected partner in a stable HIV-1 sero-discordant couple (SDC) are not available. Nevertheless, quantifying HIV infectiousness is critical to understanding HIV epidemiology and implementing prevention programs. Materials and methods: We estimated φ and examined its variation across 23 countries in sub-Saharan Africa (SSA) by constructing and analyzing a mathematical model that describes HIV dynamics among SDCs. The model was parameterized using empirical measures such as those of the nationally representative Demographic and Health Surveys. Uncertainty and sensitivity analyses were conducted to assess the robustness of the findings. Results: We estimated a median φ of 11.1 per 100 person-years across SSA. A clustering based on HIV population prevalence was observed with a median φ of 7.5 per 100 person-years in low HIV prevalence countries (<5%) compared to 19.5 per 100 person-years in high prevalence countries (>5%). The association with HIV prevalence explained 67% of the variation in φ, and suggested an increase of 0.95 per 100 person-years in φ for every 1% increase in HIV prevalence. Conclusions: Empirical measures from cohort studies appear to underestimate HIV infectiousness in SSA. The risk of HIV transmission among SDCs appears also to vary across SSA, and this may have contributed to the contrasting HIV epidemic trajectories in this continent.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalEpidemics
Volume6
DOIs
Publication statusPublished - Mar 2014

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Africa South of the Sahara
HIV-1
HIV
Uncertainty
Cluster Analysis
Epidemiology
Cohort Studies
Theoretical Models
Demography

Keywords

  • HIV transmission
  • Incidence rate
  • Mathematical model
  • Sero-discordancy
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Epidemiology
  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Microbiology
  • Parasitology
  • Virology
  • Medicine(all)

Cite this

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title = "The risk of HIV transmission within HIV-1 sero-discordant couples appears to vary across sub-saharan africa",
abstract = "Background: Representative and precise estimates for the annual risk of HIV transmission (φ) from the infected to the uninfected partner in a stable HIV-1 sero-discordant couple (SDC) are not available. Nevertheless, quantifying HIV infectiousness is critical to understanding HIV epidemiology and implementing prevention programs. Materials and methods: We estimated φ and examined its variation across 23 countries in sub-Saharan Africa (SSA) by constructing and analyzing a mathematical model that describes HIV dynamics among SDCs. The model was parameterized using empirical measures such as those of the nationally representative Demographic and Health Surveys. Uncertainty and sensitivity analyses were conducted to assess the robustness of the findings. Results: We estimated a median φ of 11.1 per 100 person-years across SSA. A clustering based on HIV population prevalence was observed with a median φ of 7.5 per 100 person-years in low HIV prevalence countries (<5{\%}) compared to 19.5 per 100 person-years in high prevalence countries (>5{\%}). The association with HIV prevalence explained 67{\%} of the variation in φ, and suggested an increase of 0.95 per 100 person-years in φ for every 1{\%} increase in HIV prevalence. Conclusions: Empirical measures from cohort studies appear to underestimate HIV infectiousness in SSA. The risk of HIV transmission among SDCs appears also to vary across SSA, and this may have contributed to the contrasting HIV epidemic trajectories in this continent.",
keywords = "HIV transmission, Incidence rate, Mathematical model, Sero-discordancy, Sub-Saharan Africa",
author = "Hiam Chemaitelly and Susanne Awad and Laith Aburaddad",
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T1 - The risk of HIV transmission within HIV-1 sero-discordant couples appears to vary across sub-saharan africa

AU - Chemaitelly, Hiam

AU - Awad, Susanne

AU - Aburaddad, Laith

PY - 2014/3

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N2 - Background: Representative and precise estimates for the annual risk of HIV transmission (φ) from the infected to the uninfected partner in a stable HIV-1 sero-discordant couple (SDC) are not available. Nevertheless, quantifying HIV infectiousness is critical to understanding HIV epidemiology and implementing prevention programs. Materials and methods: We estimated φ and examined its variation across 23 countries in sub-Saharan Africa (SSA) by constructing and analyzing a mathematical model that describes HIV dynamics among SDCs. The model was parameterized using empirical measures such as those of the nationally representative Demographic and Health Surveys. Uncertainty and sensitivity analyses were conducted to assess the robustness of the findings. Results: We estimated a median φ of 11.1 per 100 person-years across SSA. A clustering based on HIV population prevalence was observed with a median φ of 7.5 per 100 person-years in low HIV prevalence countries (<5%) compared to 19.5 per 100 person-years in high prevalence countries (>5%). The association with HIV prevalence explained 67% of the variation in φ, and suggested an increase of 0.95 per 100 person-years in φ for every 1% increase in HIV prevalence. Conclusions: Empirical measures from cohort studies appear to underestimate HIV infectiousness in SSA. The risk of HIV transmission among SDCs appears also to vary across SSA, and this may have contributed to the contrasting HIV epidemic trajectories in this continent.

AB - Background: Representative and precise estimates for the annual risk of HIV transmission (φ) from the infected to the uninfected partner in a stable HIV-1 sero-discordant couple (SDC) are not available. Nevertheless, quantifying HIV infectiousness is critical to understanding HIV epidemiology and implementing prevention programs. Materials and methods: We estimated φ and examined its variation across 23 countries in sub-Saharan Africa (SSA) by constructing and analyzing a mathematical model that describes HIV dynamics among SDCs. The model was parameterized using empirical measures such as those of the nationally representative Demographic and Health Surveys. Uncertainty and sensitivity analyses were conducted to assess the robustness of the findings. Results: We estimated a median φ of 11.1 per 100 person-years across SSA. A clustering based on HIV population prevalence was observed with a median φ of 7.5 per 100 person-years in low HIV prevalence countries (<5%) compared to 19.5 per 100 person-years in high prevalence countries (>5%). The association with HIV prevalence explained 67% of the variation in φ, and suggested an increase of 0.95 per 100 person-years in φ for every 1% increase in HIV prevalence. Conclusions: Empirical measures from cohort studies appear to underestimate HIV infectiousness in SSA. The risk of HIV transmission among SDCs appears also to vary across SSA, and this may have contributed to the contrasting HIV epidemic trajectories in this continent.

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