title: HIV sero-discordance among married HIV patients initiating anti-retroviral therapy in northern Vietnam.
abstract: In many countries in Asia, the HIV epidemic is in a concentrated phase, with high prevalence in certain risk groups, such as men who inject drugs. There is also a rapid increase of HIV among women. The latter might be due to high levels of sero-discordant couples and increasing transmission from male to female partners over time.
  
  
  
  All adult married patients initiating antiretroviral treatment at four out-patient clinics in Quang Ninh province in north-eastern Vietnam between 2007 and 2009 were asked to participate in the study. Clinical information was extracted from patients' records, and a structured questionnaire was used to collect social, demographic and economic data.
  
  
  
  Two hundred eighty-eight married patients for whom information on the HIV status of their spouse was available were included in the study. Overall, the sero-discordance rate was 58%. The sero-discordance rate was significantly higher among married males, 71% had spouses not infected, than married females, of whom 18% had spouses not infected. Other factors associated with a high rate of sero-discordance were injection drug use (IDU) history, tuberculosis (TB) history and the availability of voluntary counselling and testing (VCT) in residential locations. High sero-concordance was associated with college/university education.
  
  
  
  The sero-discordance was significantly higher among married males than married females. Other factors also related to high sero-discordance were history of IDU, history of TB and the availability of VCT in residential locations. In contrast, college/university education and female sex were significantly related to low sero-discordance. To contain the increasing HIV prevalence among women, measures should be taken to prevent transmission among sero-discordant couples.Trial registrationNCT01433601.
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors.forename: Vu
authors.initials: V
authors.lastname: Van Tam
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors.forename: Do Duy
authors.initials: DD
authors.lastname: Cuong
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Alfven
authors.affiliation: Department of Probability and Mathematical Statistics, Institute of Mathematics, Ha Noi, Vietnam.
authors.forename: Ho Dang
authors.initials: HD
authors.lastname: Phuc
authors.affiliation: Health System Research Project, Ha Noi Medical University, Ha Noi, Vietnam.
authors.forename: Nguyen Thi Kim
authors.initials: NT
authors.lastname: Chuc
authors.affiliation: Health System Research Project, Ha Noi Medical University, Ha Noi, Vietnam.
authors.forename: Nguyen Phuong
authors.initials: NP
authors.lastname: Hoa
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors.forename: Vinod
authors.initials: V
authors.lastname: Diwan
authors.affiliation: Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden ; Oxford University Clinical Research Unit, Ha Noi, Vietnam.
authors.forename: Mattias
authors.identifier: 0000-0002-0514-7445
authors.initials: M
authors.lastname: Larsson
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data*; D008875:Middle Aged; D010045:Outpatients; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: ART; Gender; HIV; Late presentation; Sero-discordance; Vietnam