Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial.
BACKGROUND
Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regional differences in HIV-1 discordance among African couples, has not previously been reported.


RESULTS
The Partners in Prevention HSV-2/HIV-1 Transmission Trial ("Partners HSV-2 Study"), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 2007. Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8-31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r = 0.74, p = 0.09).


CONCLUSIONS
HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials.
Lingappa
Jairam R
JR
University of Washington, Department of Medicine, Seattle, Washington, USA. lingappa@u.washington.edu
Lambdin
Barrot
B
Bukusi
Elizabeth Ann
EA
Ngure
Kenneth
K
Kavuma
Linda
L
Inambao
Mubiana
M
Kanweka
William
W
Allen
Susan
S
Kiarie
James N
JN
Makhema
Joseph
J
Were
Edwin
E
Manongi
Rachel
R
Coetzee
David
D
de Bruyn
Guy
G
Delany-Moretlwe
Sinead
S
Magaret
Amalia
A
Mugo
Nelly
N
Mujugira
Andrew
A
Ndase
Patrick
P
Celum
Connie
C
D000349:Africa / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D018023:HIV Seronegativity; D006801:Humans; D015995:Prevalence; D012747:Sexual Partners