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Characteristics of HIV Seroconverters in the Setting of Universal Test and Treat: Results From the SEARCH Trial in Rural Uganda and Kenya

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dc.contributor.authorNyabuti, Marilyn N.
dc.contributor.authorPetersen, Maya L.
dc.contributor.authorBukusi, Elizabeth A.
dc.contributor.authorKamya, Moses R.
dc.contributor.authorMwangwa, Florence
dc.contributor.authorKabami, Jane
dc.contributor.authorSang, Norton
dc.contributor.authorCharlebois, Edwin D.
dc.contributor.authorBalzer, Laura B.
dc.contributor.departmentKenya Medical Research Institute
dc.contributor.departmentUniversity of California - Berkeley
dc.contributor.departmentKenya Medical Research Institute
dc.contributor.departmentMakerere University
dc.contributor.departmentMakerere University
dc.contributor.departmentMakerere University
dc.contributor.departmentKenya Medical Research Institute
dc.contributor.departmentUniversity of California, San Francisco
dc.contributor.departmentUniversity of Massachusetts Amherst
dc.date2023-09-24T09:08:08.000
dc.date.accessioned2024-04-26T08:38:22Z
dc.date.available2022-08-16T00:00:00Z
dc.date.issued2021-01-01
dc.description.abstractBackground Additional progress towards HIV epidemic control requires understanding who remains at risk of HIV infection in the context of high uptake of universal testing and treatment (UTT). We sought to characterize seroconverters and risk factors in the SEARCH UTT trial (NCT01864603), which achieved high uptake of universal HIV testing and ART coverage in 32 communities of adults (>= 15 years) in rural Uganda and Kenya. Methods In a pooled cohort of 117,114 individuals with baseline HIV negative test results, we described those who seroconverted within 3 years, calculated gender-specific HIV incidence rates, evaluated adjusted risk ratios (aRR) for seroconversion using multivariable targeted maximum likelihood estimation, and assessed potential infection sources based on self-report. Results Of 704 seroconverters, 63% were women. Young (15-24 years) men comprised a larger proportion of seroconverters in Western Uganda (18%) than Eastern Uganda (6%) or Kenya (10%). After adjustment for other risk factors, men who were mobile [>= 1 month of prior year living outside community] (aRR:1.68; 95%CI:1.09,2.60) or who HIV tested at home vs. health fair (aRR:2.44; 95%CI:1.89,3.23) were more likely to seroconvert. Women who were aged <= 24 years (aRR:1.91; 95%CI:1.27,2.90), mobile (aRR:1.49; 95%CI:1.04,2.11), or reported a prior HIV test (aRR:1.34; 95%CI:1.06,1.70), or alcohol use (aRR:2.07; 95%CI:1.34,3.22) were more likely to seroconvert. Among survey responders (N = 607, 86%), suspected infection source was more likely for women than men to be >= 10 years older (28% versus 8%) or a spouse (51% vs. 31%) and less likely to be transactional sex (10% versus 16%). Conclusion In the context of universal testing and treatment, additional strategies tailored to regional variability are needed to address HIV infection risks of young women, alcohol users, mobile populations, and those engaged in transactional sex to further reduce HIV incidence rates.
dc.description.sponsorshipNIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [U01AI099959, UM1AI068636]; UCSF
dc.identifier.doihttps://doi.org/10.1371/journal.pone.0243167
dc.identifier.issn1932-6203
dc.identifier.urihttps://hdl.handle.net/20.500.14394/3756
dc.relation.ispartofPLOS ONE
dc.relation.urlhttps://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1041&amp;context=bioepi_faculty_pubs&amp;unstamped=1
dc.rightsUMass Amherst Open Access Policy
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.source.issue2
dc.source.issue16
dc.source.statuspublished
dc.subjectRISK BEHAVIOR
dc.subjectAGE-DISPARATE
dc.subjectAFRICA
dc.subjectWOMEN
dc.subjectINFECTION
dc.subjectMEN
dc.subjectSEX
dc.subjectOther Medicine and Health Sciences
dc.titleCharacteristics of HIV Seroconverters in the Setting of Universal Test and Treat: Results From the SEARCH Trial in Rural Uganda and Kenya
dc.typearticle
dc.typearticle
digcom.contributor.authorNyabuti, Marilyn N.
digcom.contributor.authorPetersen, Maya L.
digcom.contributor.authorBukusi, Elizabeth A.
digcom.contributor.authorKamya, Moses R.
digcom.contributor.authorMwangwa, Florence
digcom.contributor.authorKabami, Jane
digcom.contributor.authorSang, Norton
digcom.contributor.authorCharlebois, Edwin D.
digcom.contributor.authorBalzer, Laura B.
digcom.date.embargo2022-08-16T00:00:00-07:00
digcom.identifierbioepi_faculty_pubs/41
digcom.identifier.contextkey30825590
digcom.identifier.submissionpathbioepi_faculty_pubs/41
dspace.entity.typePublication
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