A district in Uganda with a very high HIV prevalence rate saw its annual diagnosis rate reduced by half in just six years while the rates of treatment of the virus and voluntary medical male circumcision (VMMC) soared, aidsmap reports.
A new analysis of these trends provides some of the first evidence of the population-level efficacy of a combination approach to HIV prevention that relies on the power of effective antiretroviral (ARV) treatment to essentially block transmission and on VMMC to directly lower the risk of female-to-male transmission by about 60 percent.
Findings from the Rakai Community Cohort Study were presented at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.
The prospective study recruited 5,005 residents of a fishing community in Rakai, Uganda, in 2011. The cohort members were between 15 and 49 years old. Through 2017, the study investigators surveyed the individuals to determine the proportion of those living with HIV who were on ARVs and who had a viral load below 1,000, the rate of males with VMMC, sexual risk behaviors, the annual HIV diagnosis rate and the overall rate of people living with HIV.
There was follow-up data on 1,823 individuals who tested negative for HIV in 2011. During a cumulative 5,188 years of follow-up, 134 of them tested positive for the virus.
Between 2011 and 2017, the proportion of HIV-positive individuals who were taking ARVs rose from 19 percent to 81 percent. The proportion of males with VMMC rose from 39 percent to 63 percent. The rate of viral suppression among those living with the virus rose from 33 percent to 78 percent. During this time, there were no significant changes in reported sexual risk behaviors.
During the study period, the annual HIV diagnosis rate declined from 3.97 to 1.61 diagnoses per cumulative 100 years of life. This represeted more than a 50 percent reduction in the diagnosis rate, including a 62 percent decline in the rate among women and a 55 percent decline among men. Meanwhile, the overall proportion of the study group living with HIV declined from 41 percent to 36 percent.
To read the aidsmap article, click here.
To read the conference abstract, click here.
To view a webcast of the conference presentation, click here.