Declining HIV prevalence among young pregnant women in Lusaka, Zambia

Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL, United States of America.
Bulletin of the World Health Organisation (Impact Factor: 5.09). 10/2008; 86(9):697-702. DOI: 10.2471/BLT.07.045260
Source: PubMed


HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV sero-incidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006.
We analysed HIV seroprevalence trends from two Lusaka sources: (i) antenatal data from a city-wide programme to prevent mother-to-child HIV transmission, and (ii) delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005-2006, where specimens from > 97% of public-sector births in each period were obtained and analysed.
Between July 2002 and December 2006, the Lusaka district tested 243 302 antenatal women for HIV; 54 853 (22.5%) were HIV infected. Over this period, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006 (P < 0.001). The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006. Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005-2006 (P = 0.001). Among women < or =17 years of age, seroprevalence declined from 12.1% to 7.7% (P = 0.015).
HIV seroprevalence appears to be declining among antenatal and parturient women in Lusaka. The decline is most dramatic among women < or = 17 years of age, suggesting a reduction in sero-incidence in this important age group.

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Available from: Moses Sinkala, Oct 04, 2015
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    • "These mHIV-EU infants are the majority of children affected by maternal exposure to HIV-1. Where antenatal HIV-1 infection is between 20 and 25% as in Zambia, mHIV-EU infants are a large proportion of all births [24] [25]. "
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    ABSTRACT: Background: Maternally HIV-exposed (mHIV-EU) infants have poor health even without HIV-1 infection. The responses to vaccination are less well defined. Immunity to oral Poliovirus vaccine (OPV) was studied in Zambian infants participating in a randomised controlled trial of micronutrient fortification to improve child health. Method: Maternally HIV-unexposed and mHIV-EU infants were recruited at 6 months age and randomised to basal or enriched micronutrient-fortified diets for 12 months. HIV-exposed mother-infant pairs had received perinatal nevirapine to prevent mother-to-child-transmission. In the cohort of 597 infants, neutralising-antibody titres to OPV were analysed at 18 months with respect to micronutrient fortification, maternal or infant HIV-1 infection, and human cytomegalovirus (HCMV) infection detected by antibodies and viraemia (serum DNA). Vaccine protection was defined as log2 titre>3. Results: Compared to uninfected children, HIV-1-infected children had reduced neutralising antibody titres to OPV, irrespective of diet: log2 titre difference (95% confidence interval) -3.44 (-2.41; -4.46), P<0.01. OPV antibody titres were lower in HIV-infected children with HCMV viraemia compared to those without viraemia at 18 months, but did not reach significance: difference -2.55 (-6.10; 1.01), P=0.14. Breast-feeding duration was independently associated with increasing OPV titre (P-value<0.01). In mHIV-EU children there were reduced neutralising antibody titres to Poliovirus compared with maternally HIV-unexposed, irrespective of diet, maternal education and socioeconomic status: log2 titre difference (95% confidence interval) -0.56 (-0.98; -0.15), P<0.01. This difference was noticeably decreased after adjusting for breast-feeding duration, suggesting that in our study population less breast-feeding by HIV-positive mothers could explain the reduced OPV titres in mHIV-EU infants. Conclusion: The mHIV-EU infants had reduced polio vaccine antibody titres which were associated with reduced breast-feeding duration. This has important implications for polio eradication and control of vaccine-preventable diseases, in countries where childhood HIV-1 infection and maternal exposure are public health threats.
    Vaccine 03/2013; 31(16). DOI:10.1016/j.vaccine.2013.02.044 · 3.62 Impact Factor
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    • "Clinical data from the same time period indicate that 82 percent of ANC attendees in Lusaka were offered a HIV test, 71 percent of these accepted the test offer, and 99 percent of those tested received the result (Stringer et al 2005). Since mid-2005, over 90 percent of ANC attendees at Lusaka city ANCs have been tested for HIV (Stringer et al 2008b). In Zambia as a whole, administrative data indicate that 65 percent of pregnant women in 2007 took a HIV test during an ANC visit (UNAIDS Annex 3). "
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    ABSTRACT: Between 1996 and 2008 annual donor expenditure on HIV/AIDS increased from US$300 million to US$7.7 billion. However, HIV incidence has fallen only slightly and there is little evidence of a HIV prevention intervention succeeding at scale. This paper estimates the effect of prevention of mother-to-child transmission (PMTCT) expansion on child mortality in Zambia. My results suggest that the local introduction of PMTCT reduced infant mortality rates by approximately 2 percentage points, or roughly 20 percent. This appears to be the first causal evidence of a HIV prevention intervention succeeding at scale in Sub-Saharan Africa.
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    • "Adult HIV prevalence in Zambia has been estimated at 13.5% [32], and during the last decade important shifts in the epidemic have been recorded. A decline in HIV prevalence among young people aged 15 - 24 years has been documented, probably reflecting a reduction in incidence in this age group [33,34]. A marked shift in the association between educational attainment and HIV infection to reduced risk of HIV infection in more educated groups, particularly among young people [35], has been explained by reduced risk behaviour in these groups [36]. "
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    ABSTRACT: Client-initiated HIV counselling and testing has been scaled up in many African countries, in the form of voluntary counselling and testing (VCT). Test rates have remained low, with HIV-related stigma being an important barrier to HIV testing. This study explored HIV testing decisions in one rural and one urban district in Zambia with high HIV prevalence and available antiretroviral treatment. Data were collected through 17 in-depth interviews and two focus group discussions with individuals and 10 in-depth interviews with counsellors. Interpretive description methodology was employed to analyse the data. 'To know your status' was found to be a highly charged concept yielding strong barriers against HIV testing. VCT was perceived as a diagnostic device and a gateway to treatment for the severely ill. Known benefits of prevention and early treatment were outweighed by a perceived burden of knowing your HIV status related to stigma and fear. The manner in which the VCT services were organised added to this burden. This study draws on social stigma theory to enhance the understanding of the continuity of HIV related stigma in the presence of ART, and argues that the burden of knowing an HIV status and the related reluctance to get HIV tested can be understood both as a form of label-avoidance and as strong expressions of the still powerful embodied memories of suffering and death among non-curable AIDS patients over the last decades. Hope lies in the emerging signs of a reduction in HIV related stigma experienced by those who had been tested for HIV. Further research into innovative HIV testing service designs that do not add to the burden of knowing is needed.
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