Low HIV incidence in pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa

• DOI: 10.1371/journal.pone.0181691
• Publication Date: 2017-07-27T13:42:54Z
• Authors: Geoffrey Fatti; Najma Shaikh; Debra Jackson; Ameena Goga; Jean B. Nachega; Brian Eley; Ashraf Grimwood
• Keywords: Serodiscordant

Background Young Southern African women have the highest HIV incidence globally. Pregnancy doubles risk of acquisition further, and maternal contributes significantly to paediatric burden. Little data on combination prevention interventions during pregnancy lactation are available. We measured amongst pregnant postpartum receiving a community-based intervention in high setting South Africa. Methods A cohort study that included HIV-uninfected was performed. Lay workers provided individualized counselling performed three-monthly home clinic-based individual couples testing. Male partners were referred for circumcision, sexually transmitted infections or treatment as appropriate. Kaplan-Meier analyses Cox's regression used estimate factors associated with acquisition. Results The 1356 (median age 22.5 years) received 5289 tests. Eleven new detected over 828.3 person-years (PY) follow-up, an rate 1.33 infections/100 PY (95% CI: 0.74–2.40). Antenatally, 1.49 0.64–2.93) postnatally 1.03 0.33–3.19). 53% male testing 66% eligible referral circumcision. Women within known serodiscordant couples, newly diagnosed HIV-infected partners, adjusted hazard ratio (aHR) = 32.7 3.8–282.2) aHR 126.4 33.8–472.2) had substantially increased acquisition, respectively. circumcised reduced incident infection, 0.22 0.03–1.86). Conclusions Maternal lower than previous regional studies. Community-based may reduce resource-poor settings. Expanded roll-out home-based initiating pre-exposure prophylaxis is needed