title: Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment.
abstract: OBJECTIVE
  To investigate HIV prevalence trends in a rural South African community after the scale-up of antiretroviral treatment (ART) in 2004.
  
  
  METHODS
  We estimated adult HIV prevalence (ages 15-49 years) using data from a large, longitudinal, population-based HIV surveillance in rural KwaZulu-Natal, South Africa, over the period from 2004 (the year when the public-sector ART scale-up started) to 2011. We control for selection effects due to surveillance nonparticipation using multiple imputation. We further linked the surveillance data to patient records from the local HIV treatment program to estimate ART coverage.
  
  
  RESULTS
  ART coverage of all HIV-infected people in this community increased from 0% in 2004 to 31% in 2011. Over the same observation period adult HIV prevalence increased steadily from 21 to 29%. The change in overall HIV prevalence is nearly completely explained by an increase of HIV-infected people receiving ART, and it is largely driven by increases in HIV prevalence in women and men older than 24 years.
  
  
  CONCLUSIONS
  The observed dramatic increase in adult HIV prevalence can most likely be explained by increased survival of HIV-infected people due to ART. Future studies should decompose HIV prevalence trends into HIV incidence and HIV-specific mortality changes to further improve the causal attribution of prevalence increases to treatment success rather than prevention failure.
authors.affiliation: aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa bUniversity College London Institute of Child Health, London, UK cDepartment of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Jaffer
authors.initials: J
authors.lastname: Zaidi
authors.forename: Erofili
authors.initials: E
authors.lastname: Grapsa
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D062665:Epidemiological Monitoring; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents