Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort

Simon Gregson, Owen Mugurungi, Jeffrey Eaton, Albert Takaruza, Rebecca Rhead, Rufurwokuda Maswera, Junior Mutsvangwa, Justin Mayini, Morten Skovdal, Robin Schaefer, Timothy Hallett, Lorraine Sherr, Shungu Munyati, Peter Mason, Catherine Campbell, Geoffrey P. Garnett, Constance Anesu Nyamukapa

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30 Citations (Scopus)

Abstract

PURPOSE: The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART)., PARTICIPANTS: General population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15-44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years)., FINDINGS TO DATE: HIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART., FUTURE PLANS: We plan to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome.Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Original languageEnglish
Pages (from-to)e015898
JournalBMJ open
Volume7
Issue number10
Early online date6 Oct 2017
DOIs
Publication statusPublished - Oct 2017

Keywords

  • Demographic impact
  • HIV & AIDS
  • HIV decline
  • HIV incidence
  • Sexual behaviour change
  • Zimbabwe

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