HIV prevalence and incidence in a cohort of women at higher risk for HIV acquisition in Chókwè, southern Mozambique.
BACKGROUND
Reliable HIV incidence estimates for Mozambique are limited. We conducted a prospective HIV incidence study as part of a clinical research site development initiative in Chókwè district, Gaza Province, southern Mozambique.


METHODS
Between June 2010 and October 2012, we recruited women at sites where women at higher risk of HIV infection would likely be found. We enrolled and tested 1,429 sexually active women in the screening phase and 479 uninfected women in the prospective phase. Participants were scheduled for 12+ months follow-up, when they underwent face-to-face interviews, HIV counseling and testing, and pregnancy testing. We observed a total of 373.1 woman-years (WY) of follow-up, with mean (median) of 9.4 (9.7) women-months per participant.


RESULTS
The prevalence of HIV was 29.4% (95% confidence interval [CI]: 27.0-31.8%). In multivariable logistic regression analysis, factors that remained significantly associated with prevalent HIV were: older age (OR: 0.6; 95% CI: 0.4-0.7), lower educational level (OR: 0.4; 95% CI: 0.3-0.7), and using hormonal contraception (OR: 0.6; 95% CI: 0.4-0.7) or condoms (OR: 0.5; 95% CI: 0.3-0.7). We observed an HIV incidence rate of 4.6 per 100 WY (95% CI: 2.7, 7.3). The HIV incidence was 4.8 per 100 WY (95% CI: 2.5, 8.3) in women aged 18-24 years, 4.5 per 100 WY (95% CI: 1.2, 11.4) in women aged 25-29 years and 3.2 per 100 WY (95% CI: 0.1, 18.0) in the 30-35 years stratum. None of the demographic factors or time-varying behavioral factors examined was significantly associated with incident HIV infection in bivariable analysis at p ≤ 0.10.


CONCLUSIONS
We found a high HIV incidence among sexually active young women in Chókwè, Mozambique. HIV prevention programs should be strengthened in the area, with more comprehensive reproductive health services, regular HIV testing, condom promotion, and messaging about multiple sexual partners.
FHI 360, Durham, North Carolina, United States of America.
Paul J
PJ
Feldblum
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Sónia
S
Enosse
Institute for Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
Karine
K
Dubé
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Paulo
P
Arnaldo
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Chadreque
C
Muluana
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Reginaldo
R
Banze
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Aristides
A
Nhanala
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Joana
J
Cunaca
FHI 360, Durham, North Carolina, United States of America.
Pai-Lien
PL
Chen
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
Chókwè Health Research and Training Center/Centro de Investigação e Treino em Saúde de Chókwè (CITSC), National Institute of Health, Mozambique.
Ricardo
R
Thompson
D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009073:Mozambique / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult