Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015

Sikhulile Moyo, Simani Gaseitsiwe, Terence Mohammed, Molly Pretorius Holme, Rui Wang, Kenanao Peggy Kotokwe, Corretah Boleo, Lucy Mupfumi, Etienne Kadima Yankinda, Unoda Chakalisa, Erik Van Widenfelt, Tendani Gaolathe, Mompati O. Mmalane, Scott Dryden-Peterson, Madisa Mine, Refeletswe Lebelonyane, Kara Bennett, Jean Leidner, Kathleen E. Wirth, Eric Tchetgen TchetgenKathleen Powis, Janet Moore, William Clarke, Shahin Lockman, Joseph M. Makhema, Max Essex, Vlad Novitsky

Research output: Contribution to journalArticle

Abstract

Background Botswana is close to reaching the UNAIDS “90-90-90” HIV testing, antiretroviral treatment (ART), and viral suppression goals. We sought to determine HIV incidence in this setting with both high HIV prevalence and high ART coverage. Methods We used a cross-sectional approach to assessing HIV incidence. A random, population-based sample of adults age 16–64 years was enrolled in 30 rural and peri-urban communities as part of the Botswana Combination Prevention Project (BCPP), from October 2013 – November 2015. Data and samples from the baseline household survey were used to estimate cross-sectional HIV incidence, following an algorithm that combined Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5. The HIV-1 RNA cut-off was set at 400 copies/mL. For estimation purposes, the Mean Duration of Recent Infection was 130 days and the False Recent Rate (FRR) was evaluated at values of either 0 or 0.39%. Results Among 12,610 individuals participating in the baseline household survey, HIV status was available for 12,570 participants and 3,596 of them were HIV positive. LAg-Avidity EIA data was generated for 3,581 (99.6%) of HIV-positive participants. Of 326 participants with ODn 1.5, 278 individuals were receiving ART verified through documentation and were considered to represent longstanding HIV infections. Among the remaining 48 participants who reported no use of ART, 14 had an HIV-1 RNA load 400 copies/mL (including 3 participants with ARVs in plasma) and were excluded, as potential elite/viremic controllers or undisclosed ART. Thus, 34 LAg-Avidity-EIA-recent, ARV-naïve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16–64 year old adults was estimated at 1.06% (95% CI 0.68–1.45%) with zero FRR, and at 0.64% (95% CI 0.24–1.04%) using a previously defined FRR of 0.39%. Within a subset of younger individuals 16–49 years old, the annualized HIV incidence was estimated at 1.29% (95% CI 0.82–1.77%) with zero FRR, and at 0.90% (95% CI 0.42–1.38%) with FRR set to 0.39%. Conclusions Using a cross-sectional estimate of HIV incidence from 2013–2015, we found that at the time of near achievement of the UNAIDS 90-90-90 targets, ~1% of adults (age 16–64 years) in Botswana’s rural and peri-urban communities became HIV infected annually.

Original languageEnglish (US)
Article numbere0204840
JournalPLoS One
Volume13
Issue number10
DOIs
StatePublished - Oct 1 2018

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Botswana
rural communities
Rural Population
angle of incidence
HIV
RNA
Human immunodeficiency virus 1
Density (optical)
Incidence
household surveys
HIV infections
Plasmas
absorbance
HIV-1
Testing
Assays
Antigens
Controllers
HIV Infections
testing

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Moyo, S., Gaseitsiwe, S., Mohammed, T., Holme, M. P., Wang, R., Kotokwe, K. P., ... Novitsky, V. (2018). Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015. PLoS One, 13(10), [e0204840]. https://doi.org/10.1371/journal.pone.0204840

Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015. / Moyo, Sikhulile; Gaseitsiwe, Simani; Mohammed, Terence; Holme, Molly Pretorius; Wang, Rui; Kotokwe, Kenanao Peggy; Boleo, Corretah; Mupfumi, Lucy; Yankinda, Etienne Kadima; Chakalisa, Unoda; Van Widenfelt, Erik; Gaolathe, Tendani; Mmalane, Mompati O.; Dryden-Peterson, Scott; Mine, Madisa; Lebelonyane, Refeletswe; Bennett, Kara; Leidner, Jean; Wirth, Kathleen E.; Tchetgen, Eric Tchetgen; Powis, Kathleen; Moore, Janet; Clarke, William; Lockman, Shahin; Makhema, Joseph M.; Essex, Max; Novitsky, Vlad.

In: PLoS One, Vol. 13, No. 10, e0204840, 01.10.2018.

Research output: Contribution to journalArticle

Moyo, S, Gaseitsiwe, S, Mohammed, T, Holme, MP, Wang, R, Kotokwe, KP, Boleo, C, Mupfumi, L, Yankinda, EK, Chakalisa, U, Van Widenfelt, E, Gaolathe, T, Mmalane, MO, Dryden-Peterson, S, Mine, M, Lebelonyane, R, Bennett, K, Leidner, J, Wirth, KE, Tchetgen, ET, Powis, K, Moore, J, Clarke, W, Lockman, S, Makhema, JM, Essex, M & Novitsky, V 2018, 'Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015', PLoS One, vol. 13, no. 10, e0204840. https://doi.org/10.1371/journal.pone.0204840
Moyo, Sikhulile ; Gaseitsiwe, Simani ; Mohammed, Terence ; Holme, Molly Pretorius ; Wang, Rui ; Kotokwe, Kenanao Peggy ; Boleo, Corretah ; Mupfumi, Lucy ; Yankinda, Etienne Kadima ; Chakalisa, Unoda ; Van Widenfelt, Erik ; Gaolathe, Tendani ; Mmalane, Mompati O. ; Dryden-Peterson, Scott ; Mine, Madisa ; Lebelonyane, Refeletswe ; Bennett, Kara ; Leidner, Jean ; Wirth, Kathleen E. ; Tchetgen, Eric Tchetgen ; Powis, Kathleen ; Moore, Janet ; Clarke, William ; Lockman, Shahin ; Makhema, Joseph M. ; Essex, Max ; Novitsky, Vlad. / Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015. In: PLoS One. 2018 ; Vol. 13, No. 10.
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abstract = "Background Botswana is close to reaching the UNAIDS “90-90-90” HIV testing, antiretroviral treatment (ART), and viral suppression goals. We sought to determine HIV incidence in this setting with both high HIV prevalence and high ART coverage. Methods We used a cross-sectional approach to assessing HIV incidence. A random, population-based sample of adults age 16–64 years was enrolled in 30 rural and peri-urban communities as part of the Botswana Combination Prevention Project (BCPP), from October 2013 – November 2015. Data and samples from the baseline household survey were used to estimate cross-sectional HIV incidence, following an algorithm that combined Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5. The HIV-1 RNA cut-off was set at 400 copies/mL. For estimation purposes, the Mean Duration of Recent Infection was 130 days and the False Recent Rate (FRR) was evaluated at values of either 0 or 0.39{\%}. Results Among 12,610 individuals participating in the baseline household survey, HIV status was available for 12,570 participants and 3,596 of them were HIV positive. LAg-Avidity EIA data was generated for 3,581 (99.6{\%}) of HIV-positive participants. Of 326 participants with ODn 1.5, 278 individuals were receiving ART verified through documentation and were considered to represent longstanding HIV infections. Among the remaining 48 participants who reported no use of ART, 14 had an HIV-1 RNA load 400 copies/mL (including 3 participants with ARVs in plasma) and were excluded, as potential elite/viremic controllers or undisclosed ART. Thus, 34 LAg-Avidity-EIA-recent, ARV-na{\"i}ve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16–64 year old adults was estimated at 1.06{\%} (95{\%} CI 0.68–1.45{\%}) with zero FRR, and at 0.64{\%} (95{\%} CI 0.24–1.04{\%}) using a previously defined FRR of 0.39{\%}. Within a subset of younger individuals 16–49 years old, the annualized HIV incidence was estimated at 1.29{\%} (95{\%} CI 0.82–1.77{\%}) with zero FRR, and at 0.90{\%} (95{\%} CI 0.42–1.38{\%}) with FRR set to 0.39{\%}. Conclusions Using a cross-sectional estimate of HIV incidence from 2013–2015, we found that at the time of near achievement of the UNAIDS 90-90-90 targets, ~1{\%} of adults (age 16–64 years) in Botswana’s rural and peri-urban communities became HIV infected annually.",
author = "Sikhulile Moyo and Simani Gaseitsiwe and Terence Mohammed and Holme, {Molly Pretorius} and Rui Wang and Kotokwe, {Kenanao Peggy} and Corretah Boleo and Lucy Mupfumi and Yankinda, {Etienne Kadima} and Unoda Chakalisa and {Van Widenfelt}, Erik and Tendani Gaolathe and Mmalane, {Mompati O.} and Scott Dryden-Peterson and Madisa Mine and Refeletswe Lebelonyane and Kara Bennett and Jean Leidner and Wirth, {Kathleen E.} and Tchetgen, {Eric Tchetgen} and Kathleen Powis and Janet Moore and William Clarke and Shahin Lockman and Makhema, {Joseph M.} and Max Essex and Vlad Novitsky",
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T1 - Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015

AU - Moyo, Sikhulile

AU - Gaseitsiwe, Simani

AU - Mohammed, Terence

AU - Holme, Molly Pretorius

AU - Wang, Rui

AU - Kotokwe, Kenanao Peggy

AU - Boleo, Corretah

AU - Mupfumi, Lucy

AU - Yankinda, Etienne Kadima

AU - Chakalisa, Unoda

AU - Van Widenfelt, Erik

AU - Gaolathe, Tendani

AU - Mmalane, Mompati O.

AU - Dryden-Peterson, Scott

AU - Mine, Madisa

AU - Lebelonyane, Refeletswe

AU - Bennett, Kara

AU - Leidner, Jean

AU - Wirth, Kathleen E.

AU - Tchetgen, Eric Tchetgen

AU - Powis, Kathleen

AU - Moore, Janet

AU - Clarke, William

AU - Lockman, Shahin

AU - Makhema, Joseph M.

AU - Essex, Max

AU - Novitsky, Vlad

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background Botswana is close to reaching the UNAIDS “90-90-90” HIV testing, antiretroviral treatment (ART), and viral suppression goals. We sought to determine HIV incidence in this setting with both high HIV prevalence and high ART coverage. Methods We used a cross-sectional approach to assessing HIV incidence. A random, population-based sample of adults age 16–64 years was enrolled in 30 rural and peri-urban communities as part of the Botswana Combination Prevention Project (BCPP), from October 2013 – November 2015. Data and samples from the baseline household survey were used to estimate cross-sectional HIV incidence, following an algorithm that combined Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5. The HIV-1 RNA cut-off was set at 400 copies/mL. For estimation purposes, the Mean Duration of Recent Infection was 130 days and the False Recent Rate (FRR) was evaluated at values of either 0 or 0.39%. Results Among 12,610 individuals participating in the baseline household survey, HIV status was available for 12,570 participants and 3,596 of them were HIV positive. LAg-Avidity EIA data was generated for 3,581 (99.6%) of HIV-positive participants. Of 326 participants with ODn 1.5, 278 individuals were receiving ART verified through documentation and were considered to represent longstanding HIV infections. Among the remaining 48 participants who reported no use of ART, 14 had an HIV-1 RNA load 400 copies/mL (including 3 participants with ARVs in plasma) and were excluded, as potential elite/viremic controllers or undisclosed ART. Thus, 34 LAg-Avidity-EIA-recent, ARV-naïve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16–64 year old adults was estimated at 1.06% (95% CI 0.68–1.45%) with zero FRR, and at 0.64% (95% CI 0.24–1.04%) using a previously defined FRR of 0.39%. Within a subset of younger individuals 16–49 years old, the annualized HIV incidence was estimated at 1.29% (95% CI 0.82–1.77%) with zero FRR, and at 0.90% (95% CI 0.42–1.38%) with FRR set to 0.39%. Conclusions Using a cross-sectional estimate of HIV incidence from 2013–2015, we found that at the time of near achievement of the UNAIDS 90-90-90 targets, ~1% of adults (age 16–64 years) in Botswana’s rural and peri-urban communities became HIV infected annually.

AB - Background Botswana is close to reaching the UNAIDS “90-90-90” HIV testing, antiretroviral treatment (ART), and viral suppression goals. We sought to determine HIV incidence in this setting with both high HIV prevalence and high ART coverage. Methods We used a cross-sectional approach to assessing HIV incidence. A random, population-based sample of adults age 16–64 years was enrolled in 30 rural and peri-urban communities as part of the Botswana Combination Prevention Project (BCPP), from October 2013 – November 2015. Data and samples from the baseline household survey were used to estimate cross-sectional HIV incidence, following an algorithm that combined Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5. The HIV-1 RNA cut-off was set at 400 copies/mL. For estimation purposes, the Mean Duration of Recent Infection was 130 days and the False Recent Rate (FRR) was evaluated at values of either 0 or 0.39%. Results Among 12,610 individuals participating in the baseline household survey, HIV status was available for 12,570 participants and 3,596 of them were HIV positive. LAg-Avidity EIA data was generated for 3,581 (99.6%) of HIV-positive participants. Of 326 participants with ODn 1.5, 278 individuals were receiving ART verified through documentation and were considered to represent longstanding HIV infections. Among the remaining 48 participants who reported no use of ART, 14 had an HIV-1 RNA load 400 copies/mL (including 3 participants with ARVs in plasma) and were excluded, as potential elite/viremic controllers or undisclosed ART. Thus, 34 LAg-Avidity-EIA-recent, ARV-naïve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16–64 year old adults was estimated at 1.06% (95% CI 0.68–1.45%) with zero FRR, and at 0.64% (95% CI 0.24–1.04%) using a previously defined FRR of 0.39%. Within a subset of younger individuals 16–49 years old, the annualized HIV incidence was estimated at 1.29% (95% CI 0.82–1.77%) with zero FRR, and at 0.90% (95% CI 0.42–1.38%) with FRR set to 0.39%. Conclusions Using a cross-sectional estimate of HIV incidence from 2013–2015, we found that at the time of near achievement of the UNAIDS 90-90-90 targets, ~1% of adults (age 16–64 years) in Botswana’s rural and peri-urban communities became HIV infected annually.

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