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FIFTY-PERCENT REDUCTION IN HIV INCIDENCE IN CHOKWE DISTRICT, MOZAMBIQUE, 2014-2017
Duncan A. MacKellar1, Robert Nelson1, Ricardo Thompson2, Isabelle Casavant3, Sherri Pals1, Ishani Pathmanathan1, Judite Cardoso4, Dawud Ujamaa1, Ernest L. Yufenyuy1, Katrina Sleeman1, Victor Chivurre2, Noela Chicuecue2, Keydra Oladapo3, Aleny M. Couto2, Alfredo Vergara3
1CDC, Atlanta, GA, USA,2Ministry of Health, Maputo, Mozambique,3CDC Mozambique, Maputo, Mozambique,4Jhpiego, Maputo, Mozambique
Reduction of HIV incidence attributed to increasing coverage of a combination of biomedical interventions (CBI) has not been evaluated in Mozambique. We assessed in the Chokwe Health Demographic Surveillance System (CHDSS) trends in HIV incidence, and prevalence of viral load suppression (VLS, <1000 RNA copies/mL) and CBI including circumcision among men (MC), and HIV testing, diagnosis, and use of antiretroviral therapy (ART) among persons living with HIV (PLHIV). Located in Chokwe District, CHDSS includes ~95,000 residents.
Since 2014, HIV testing services (HTS) including referral for MC and follow-up linkage-to-care for PLHIV has been offered annually at all ~20,515 CHDSS households. HIV incidence and prevalence of HIV, VLS, and CBI were assessed with annual surveys of residents aged 15-59 years in 10% (2014-2015) or 20% (2016-2017) of randomly selected households. Dried blood spots of participating PLHIV were tested at CDC for VLS and recent infection (mean <161 days). Annualized HIV incidence was calculated with a standard formula; participants on ART or with VLS were defined as having longstanding infection. Census-weighted CHDSS HIV incidence, incidence rate ratios (IRR), and prevalence of HIV, VLS, and CBI were estimated for the first three survey rounds (R1-R3, April 2014–March 2017). District health facilities offered ART for all PLHIV beginning in mid-2016, R3.
During R1-R3, 39,586 (72%) of 55,287 residents aged 15-59 years tested for HIV at home at least once, and 3,449 (886 men) were newly HIV diagnosed and provided linkage services. HIV prevalence decreased from 27.3% in R1 to 25.7% in R3 (p< 0.05) (Table). By R3, prevalence of MC, and prior HIV diagnosis, current ART use, and VLS among PLHIV increased 14.0%-21.6% (Table). Of 2,750 PLHIV, 30 (1.1%) had been recently infected (R1, 1.5%; R2, 1.2%; R3, 0.7%). HIV incidence decreased 53% overall (p<0.05), and 54% and 51% (p>0.05) among men and women, respectively (Table). Among persons aged 15-24 and 25-59 years, HIV incidence fell from 1.3% (0.0-2.5%) and 2.4% (0.6-4.3%) in R1 to 0.4% (0.0-1.0%) and 1.3% (0.1-2.4%) in R3, respectively.
In a high HIV prevalence district in Mozambique, increasing population prevalence of HIV biomedical interventions was associated with increasing prevalence of VLS and an approximate 50% reduction in HIV incidence among adults. Annual home-based HTS with referral and linkage services can help achieve rapid scale up of CBI, increased VLS, and reduced HIV incidence.