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.authorMaya, L. Petersen
dc.contributor.authorBukusi, Elizabeth A.
dc.contributor.authorKamya, Moses R.
dc.contributor.authorMwangwa, Florence
dc.contributor.authorKabami, Jane
dc.contributor.authorCharlebois, Edwin D.
dc.contributor.authorTamara, D. Clark
dc.contributor.authorChamie, Gabriel
dc.contributor.authorHavlir, Diane V.
dc.contributor.authorAyieko, James
dc.date.accessioned2022-08-24T06:49:35Z
dc.date.available2022-08-24T06:49:35Z
dc.date.issued2021
dc.description.abstractAdditional 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. 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. 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%). 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.en_US
dc.identifier.citationNyabuti, M. N., Petersen, M. L., Bukusi, E. A., Kamya, M. R., Mwangwa, F., Kabami, J., ... & Ayieko, J. (2021). Characteristics of HIV seroconverters in the setting of universal test and treat: results from the SEARCH trial in rural Ughttps://doi.org/10.1371/journal.pone.0243167anda and Kenya. PloS one, 16(2), e0243167.en_US
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/4406
dc.language.isoenen_US
dc.publisherPloS oneen_US
dc.titleCharacteristics of HIV Seroconverters in the Setting of Universal Test and Treat: Results from the SEARCH trial in rural Uganda and Kenyaen_US
dc.typeArticleen_US
dc.typeBooken_US
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