|
|
Abstract
Changes in sexual behavior and risk of HIV transmission after two years of antiretroviral therapy and prevention interventions in rural Uganda
R. Bunnell1, N. Wamai2, J.P. Ekwaru1, D. Moore2, W. Were2, S. Bechange1, A. Coutinho3, E. Madraa4, J. Mermin1
Background: The long-term impact of antiretroviral therapy (ART) on sexual HIV transmission risk among HIV-infected persons in Africa is unknown. We assessed changes in sexual behavior and estimated HIV transmission from HIV-infected adults after 2 years of ART in Tororo, Uganda.
Methods: Between May 2003 and December 2004 we enrolled and followed 926 drug-naive HIV-infected adults in a home-based AIDS care program that included HIV prevention counseling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, we assessed participants’ HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. We compared risky sex rates using a Poisson regression model and estimated transmission risk per partner based on established viral load-specific transmission rates. Sero-conversion rates among cohabitating sero-discordant partners with laboratory results were assessed at 24 months.
Results: By January 2006, 454 (49%) participants had reached 24 months of follow-up. Sexual activity increased from 28% at baseline to 38% (p<0.001) (women: 21%-31%; men: 47-61%) at 24 months. The proportion of sexually active participants reporting any risky sex decreased from 22% to 15% (p=.062). Median viral load among those reporting risky sex was 122,500 copies/ml at baseline and undetectable at follow-up. At 2 years, the reduction in estimated risk of HIV transmission from cohort members was 98%, from 45.7 to 1.0 per 1000 person years. One sero-conversion occurred within 62 cohabitating sero-discordant partners during 1st year of therapy; no sero-conversions occurred in the second year.
Conclusions: Providing ART and on-going prevention interventions was associated with a reduced estimated risk of HIV transmission among HIV-infected Ugandan adults after two years of therapy, despite an increase in overall sexual activity. Integrated ART and prevention programs may reduce HIV transmission in Africa.
AIDS 2006 - XVI International AIDS Conference
Abstract no.
MOAC0204
Suggested Citation
"R.Bunnell, et al.
Changes in sexual behavior and risk of HIV transmission after two years of antiretroviral therapy and prevention interventions in rural Uganda.
Oral abstract session:
AIDS 2006 - XVI International AIDS Conference:
Abstract no.
MOAC0204"
|
|
|