HIV incidence in a cohort of women at higher risk in Beira, Mozambique: prospective study 2009-2012.
BACKGROUND
HIV is prevalent in Sofala Province, Mozambique. To inform future prevention research, we undertook a study in the provincial capital (Beira) to measure HIV incidence in women at higher risk of HIV and assess the feasibility of recruiting and retaining them as research participants.


METHODS
Women age 18-35 were recruited from schools and places where women typically meet potential sexual partners. Eligibility criteria included HIV-seronegative status and self-report of at least 2 sexual partners in the last month. History of injection drug use was an exclusion criterion, but pregnancy was not. Participants were scheduled for monthly follow-up for 12 months, when they underwent face-to-face interviews, HIV counseling and testing, and pregnancy testing.


RESULTS
387 women were eligible and contributed follow-up data. Most were from 18-24 years old (median 21). Around one-third of participants (33.8%) reported at least one new sexual partner in the last month. Most women (65.5%) reported not using a modern method of contraception at baseline. Twenty-two women seroconverted for a prospective HIV incidence of 6.5 per 100 woman-years (WY; 95% confidence interval (CI): 4.1-9.9). Factors associated with HIV seroconversion in the multivariable analysis were: number of vaginal sex acts without using condoms with partners besides primary partner in the last 7 days (hazard ratio (HR) 1.7; 95% CI: 1.2-2.5) and using a form of contraception at baseline other than hormonal or condoms (vs. no method; HR 25.3; 95% CI: 2.5-253.5). The overall retention rate was 80.0% for the entire follow-up period.


CONCLUSIONS
We found a high HIV incidence in a cohort of young women reporting risky sexual behavior in Beira, Mozambique. HIV prevention programs should be strengthened. Regular HIV testing and condom use should be encouraged, particularly among younger women with multiple sexual partners.
FHI 360, Durham, North Carolina, United States of America ; United States Military HIV Research Program (MHRP), Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, Maryland, United States of America.
Karine
K
Dubé
Universidade Católica de Moçambique/Catholic University of Mozambique, (UCM) Centro de Investigação de Doenças Infecciosas/Research Center for Infectious Diseases (CIDI), Beira, Mozambique.
Arlinda
A
Zango
Amsterdam Institute for Global Health and Development (AIGHD) and Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands ; University of Liverpool, Institute of Infection and Global Health, Liverpool, United Kingdom.
Janneke
J
van de Wijgert
Universidade Católica de Moçambique/Catholic University of Mozambique, (UCM) Centro de Investigação de Doenças Infecciosas/Research Center for Infectious Diseases (CIDI), Beira, Mozambique.
Ivete
I
Meque
Universidade Católica de Moçambique/Catholic University of Mozambique, (UCM) Centro de Investigação de Doenças Infecciosas/Research Center for Infectious Diseases (CIDI), Beira, Mozambique.
Josefo J
JJ
Ferro
Universidade Católica de Moçambique/Catholic University of Mozambique, (UCM) Centro de Investigação de Doenças Infecciosas/Research Center for Infectious Diseases (CIDI), Beira, Mozambique.
Fidelina
F
Cumbe
FHI 360, Durham, North Carolina, United States of America.
Pai Lien
PL
Chen
FHI 360, Durham, North Carolina, United States of America.
Sabrina
S
Ma
FHI 360, Durham, North Carolina, United States of America.
Erik
E
Jolles
Universidade Católica de Moçambique/Catholic University of Mozambique, (UCM) Centro de Investigação de Doenças Infecciosas/Research Center for Infectious Diseases (CIDI), Beira, Mozambique.
Afonso
A
Fumo
United States Military HIV Research Program (MHRP), Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (HJF), Bethesda, Maryland, United States of America.
Merlin L
ML
Robb
FHI 360, Durham, North Carolina, United States of America.
Paul J
PJ
Feldblum
D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D009073:Mozambique / Q000453:epidemiology; D015999:Multivariate Analysis; D018579:Patient Selection; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior / Q000502:physiology*