title: Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial.
abstract: 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.
authors.affiliation: University of Washington, Department of Medicine, Seattle, Washington, USA. lingappa@u.washington.edu
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Lingappa
authors.forename: Barrot
authors.initials: B
authors.lastname: Lambdin
authors.forename: Elizabeth Ann
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ngure
authors.forename: Linda
authors.initials: L
authors.lastname: Kavuma
authors.forename: Mubiana
authors.initials: M
authors.lastname: Inambao
authors.forename: William
authors.initials: W
authors.lastname: Kanweka
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
authors.forename: James N
authors.initials: JN
authors.lastname: Kiarie
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Edwin
authors.initials: E
authors.lastname: Were
authors.forename: Rachel
authors.initials: R
authors.lastname: Manongi
authors.forename: David
authors.initials: D
authors.lastname: Coetzee
authors.forename: Guy
authors.initials: G
authors.lastname: de Bruyn
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.forename: Andrew
authors.initials: A
authors.lastname: Mujugira
authors.forename: Patrick
authors.initials: P
authors.lastname: Ndase
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
mesh_terms: D000349:Africa / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D018023:HIV Seronegativity; D006801:Humans; D015995:Prevalence; D012747:Sexual Partners