Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa

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dc.contributor.authorAdam Akullian
dc.contributor.authorAlain Vandormael
dc.contributor.authorJoel C Miller
dc.contributor.authorAnna Bershteyn
dc.contributor.authorEdward Wenger
dc.contributor.authorDiego Cuadros
dc.contributor.authorDickman Gareta
dc.contributor.authorTill Bärnighausen
dc.contributor.authorKobus Herbst
dc.contributor.authorFrank Tanser
dc.date.accessioned2024-07-25T09:02:57Z
dc.date.available2024-07-25T09:02:57Z
dc.date.issued2021-07-13
dc.description.abstractRecent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist to support these projections. We conducted a population-based cohort study over a 16-y period (2004 to 2019), spanning the early scale-up of antiretroviral therapy and voluntary medical male circumcision, to estimate changes in the age distribution of HIV incidence in a hyperepidemic region of KwaZulu-Natal, South Africa, where adult HIV incidence has recently declined. Median age of HIV seroconversion increased by 5.5 y in men and 3.0 y in women, and the age of peak HIV incidence increased by 5.0 y in men and 2.0 y in women. Incidence declined disproportionately among young men (64% in men 15 to 19, 68% in men 20 to 24, and 46% in men 25 to 29) and young women (44% in women 15 to 19, 24% in women 20 to 24) comparing periods pre- versus post-universal test and treat. Incidence was stable (<20% change) in women aged 30 to 39 and men aged 30 to 34. Age shifts in incidence occurred after 2012 and were observed earlier in men than in women. These results provide direct epidemiological evidence of the changing demographics of HIV risk in sub-Saharan Africa in the era of large-scale treatment and prevention. More attention is needed to address lagging incidence decline among older individuals.
dc.description.submitterPM2024
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/39850
dc.language.isoen
dc.schoolSchool of Public Health
dc.subjectHIV incidence; HIV prevention; age distribution; antiretroviral therapy.
dc.titleLarge age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa
dc.typeArticle
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