93 results found
Eaton JW, Takavarasha FR, Schumacher CM, et al., 2014, Trends in Concurrency, Polygyny, and Multiple Sex Partnerships During a Decade of Declining HIV Prevalence in Eastern Zimbabwe, JOURNAL OF INFECTIOUS DISEASES, Vol: 210, Pages: S562-S568, ISSN: 0022-1899
Pufall EL, Nyamukapa C, Eaton JW, et al., 2014, HIV in Children in a General Population Sample in East Zimbabwe: Prevalence, Causes and Effects, PLOS One, Vol: 9, ISSN: 1932-6203
Background: There are an estimated half-million children living with HIV in sub-Saharan Africa. The predominant source ofinfection is presumed to be perinatal mother-to-child transmission, but general population data about paediatric HIV aresparse. We characterise the epidemiology of HIV in children in sub-Saharan Africa by describing the prevalence, possiblesource of infection, and effects of paediatric HIV in a southern African population.Methods: From 2009 to 2011, we conducted a household-based survey of 3389 children (aged 2–14 years) in Manicaland,eastern Zimbabwe (response rate: 73.5%). Data about socio-demographic correlates of HIV, risk factors for infection, andeffects on child health were analysed using multi-variable logistic regression. To assess the plausibility of mother-to-childtransmission, child HIV infection was linked to maternal survival and HIV status using data from a 12-year adult HIV cohort.Results: HIV prevalence was (2.2%, 95% CI: 1.6–2.8%) and did not differ significantly by sex, socio-economic status, location,religion, or child age. Infected children were more likely to be underweight (19.6% versus 10.0%, p = 0.03) or stunted (39.1%versus 30.6%, p = 0.04) but did not report poorer physical or psychological ill-health. Where maternal data were available,reported mothers of 61/62 HIV-positive children were deceased or HIV-positive. Risk factors for other sources of infectionwere not associated with child HIV infection, including blood transfusion, vaccinations, caring for a sick relative, and sexualabuse. The observed flat age-pattern of HIV prevalence was consistent with UNAIDS estimates which assumes perinatalmother-to-child transmission, although modelled prevalence was higher than observed prevalence. Only 19/73 HIV-positivechildren (26.0%) were diagnosed, but, of these, 17 were on antiretroviral therapy.Conclusions: Childhood HIV infection likely arises predominantly from mother-to-child transmission and is associated wit
Eaton JW, Hallett TB, 2014, Why the proportion of transmission during early-stage HIV infection does not predict the long-term impact of treatment on HIV incidence, PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, Vol: 111, Pages: 16202-16207, ISSN: 0027-8424
Eaton JW, Rehle TM, Jooste S, et al., 2014, Recent HIV prevalence trends among pregnant women and all women in sub-Saharan Africa: implications for HIV estimates, AIDS, Vol: 28, Pages: S507-S514, ISSN: 0269-9370
Objectives: National population-wide HIV prevalence and incidence trends in sub-Saharan Africa (SSA) are indirectly estimated using HIV prevalence measured among pregnant women attending antenatal clinics (ANC), among other data. We evaluated whether recent HIV prevalence trends among pregnant women are representative of general population trends.Design: Serial population-based household surveys in 13 SSA countries.Methods: We calculated HIV prevalence trends among all women aged 15–49 years and currently pregnant women between surveys conducted from 2003 to 2008 (period 1) and 2009 to 2012 (period 2). Log-binomial regression was used to test for a difference in prevalence trend between the two groups. Prevalence among pregnant women was age-standardized to represent the age distribution of all women.Results: Pooling data for all countries, HIV prevalence declined among pregnant women from 6.5 [95% confidence interval (CI) 5.3–7.9%] to 5.3% (95% CI 4.2–6.6%) between periods 1 and 2, whereas it remained unchanged among all women at 8.4% (95% CI 8.0–8.9%) in period 1 and 8.3% (95% CI 7.9–8.8%) in period 2. Prevalence declined by 18% (95% CI -9–38%) more in pregnant women than nonpregnant women. Estimates were similar in Western, Eastern, and Southern regions of SSA; none were statistically significant (P > 0.05). HIV prevalence decreased significantly among women aged 15–24 years while increasing significantly among women 35–49 years, who represented 29% of women but only 15% of pregnant women. Age-standardization of prevalence in pregnant women did not reconcile the discrepant trends because at older ages prevalence was lower among pregnant women than nonpregnant women.Conclusion: As HIV prevalence in SSA has shifted toward older, less-fertile women, HIV prevalence among pregnant women has declined more rapidly than prevalence in women overall. Interpretation of ANC prevalence data to inform national HIV estimates sh
Brown T, Bao L, Eaton JW, et al., 2014, Improvements in prevalence trend fitting and incidence estimation in EPP 2013, AIDS, Vol: 28, Pages: S415-S425, ISSN: 0269-9370
Objective: Describe modifications to the latest version of the Joint United Nations Programme on AIDS (UNAIDS) Estimation and Projection Package component of Spectrum (EPP 2013) to improve prevalence fitting and incidence trend estimation in national epidemics and global estimates of HIV burden.Methods: Key changes made under the guidance of the UNAIDS Reference Group on Estimates, Modelling and Projections include: availability of a range of incidence calculation models and guidance for selecting a model; a shift to reporting the Bayesian median instead of the maximum likelihood estimate; procedures for comparison and validation against reported HIV and AIDS data; incorporation of national surveys as an integral part of the fitting and calibration procedure, allowing survey trends to inform the fit; improved antenatal clinic calibration procedures in countries without surveys; adjustment of national antiretroviral therapy reports used in the fitting to include only those aged 15–49 years; better estimates of mortality among people who inject drugs; and enhancements to speed fitting.Results: The revised models in EPP 2013 allow closer fits to observed prevalence trend data and reflect improving understanding of HIV epidemics and associated data.
Pufall EL, Gregson S, Eaton JW, et al., 2014, The contribution of schools to supporting the well being of children affected by HIV in eastern Zimbabwe, AIDS, Vol: 28, Pages: S379-S387, ISSN: 0269-9370
Hallett TB, Eaton JW, Menzies N, 2014, Beware of using invalid transmission models to guide HIV health policy Reply, LANCET GLOBAL HEALTH, Vol: 2, Pages: E261-E261, ISSN: 2214-109X
Martin NK, Devine A, Eaton JW, et al., 2014, MODELING THE IMPACT OF EARLY ANTIRETROVIRAL THERAPY FOR ADULTS COINFECTED WITH HIV AND HEPATITIS B OR C IN SOUTH AFRICA, 49th Annual International Liver Congress of the European-Association-for-the-Study-of-the-Liver, Publisher: ELSEVIER SCIENCE BV, Pages: S483-S483, ISSN: 0168-8278
Pufall EL, Nyamukapa C, Eaton JW, et al., 2014, The impact of HIV on children's education in eastern Zimbabwe, AIDS Care, Vol: 26, Pages: 1136-1143, ISSN: 0954-0121
Little is known about how HIV impacts directly and indirectly on receiving, or particularly succeeding in, education in sub-Saharan Africa. To address this gap, we used multivariable logistic regression to determine the correlation between education outcomes in youth (aged 15–24) (being in the correct grade-for-age, primary school completion and having at least five “O” level passes) and being HIV-positive; having an HIV-positive parent; being a young carer; or being a maternal, paternal or double orphan, in five rounds (1998–2011) of a general population survey from eastern Zimbabwe. The fifth survey round (2009–2011) included data on children aged 6–17, which were analysed for the impacts of the above risk factors on regular attendance in primary and secondary schools and being in the correct grade-for-age. For data pooled over all rounds, being HIV-positive had no association with primary school completion, “O” level passes, or being in the correct grade-for-age in adolescents aged 16–17 years. Additionally, HIV status had no significant association with any education outcomes in children aged 6–17 surveyed in 2009–2011. In 2009–2011, being a young carer was associated with lower attendance in secondary school (69% vs. 85%, AOR: 0.44; p=0.02), whilst being a maternal (75% vs. 83%, AOR: 0.67; p<0.01), paternal (76% vs. 83%, AOR: 0.67; p=0.02) or double (75% vs. 83%, AOR: 0.68; p=0.02) orphan was associated with decreased odds of being in the correct grade-for-age. All forms of orphanhood also significantly decreased the odds of primary school completion in youths surveyed from 1998 to 2011 (all p<0.01). We found no evidence that HIV status affects education but further evidence that orphans do experience worse education outcomes than other children. Combination approaches that provide incentives for children to attend school and equip schools with tools to support vulnerable children may
Robertson L, Mushati P, Skovdal M, et al., 2014, Involving Communities in the Targeting of Cash Transfer Programs for Vulnerable Children: Opportunities and Challenges, WORLD DEVELOPMENT, Vol: 54, Pages: 325-337, ISSN: 0305-750X
Cori A, Ayles H, Beyers N, et al., 2014, HPTN 071 (PopART): A Cluster-Randomized Trial of the Population Impact of an HIV Combination Prevention Intervention Including Universal Testing and Treatment: Mathematical Model, PLOS ONE, Vol: 9, ISSN: 1932-6203
Hallett TB, Menzies NA, Revill P, et al., 2014, Using modeling to inform international guidelines for antiretroviral treatment, AIDS, Vol: 28, Pages: S1-S4, ISSN: 0269-9370
Martin NK, Devine A, Eaton JW, et al., 2014, Modeling the impact of early antiretroviral therapy for adults coinfected with HIV and hepatitis B or C in South Africa, AIDS, Vol: 28, Pages: S35-S46, ISSN: 0269-9370
Eaton JW, Menzies NA, Stover J, et al., 2014, Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models, LANCET GLOBAL HEALTH, Vol: 2, Pages: E23-E34, ISSN: 2214-109X
Pretorius C, Menzies NA, Chindelevitch L, et al., 2014, The potential effects of changing HIV treatment policy on tuberculosis outcomes in South Africa: results from three tuberculosis-HIV transmission models, AIDS, Vol: 28, Pages: S25-S34, ISSN: 0269-9370
van de Vijver DAMC, Nichols BE, Abbas UL, et al., 2013, Preexposure prophylaxis will have a limited impact on HIV-1 drug resistance in sub-Saharan Africa: a comparison of mathematical models, AIDS, Vol: 27, Pages: 2943-2951, ISSN: 0269-9370
McGrath N, Eaton JW, Bärnighausen TW, et al., 2013, Sexual behaviour in a rural high HIV prevalence South African community: time trends in the antiretroviral treatment era, AIDS, Vol: 27, Pages: 2461-2470, ISSN: 1473-5571
OBJECTIVES: Data from generalized epidemic settings have consistently found that patients on antiretroviral therapy (ART) reduce sexual risk behaviours, but how sexual behaviour changes in the general population in response to ART availability, including amongst HIV-uninfected and undiagnosed adults, has not been characterized in these settings. DESIGN: General population open cohort. METHODS: We report trends in sexual behaviour indicators for men aged 17-54 years and women aged 17-49 years in rural KwaZulu-Natal province, based on annual sexual behaviour surveys during ART scale-up from 2005 to 2011. Estimates are adjusted for survey nonparticipation and nonresponse to individual survey items using inverse probability weighting and multiple imputation. Trends are presented by HIV status, knowledge of status, age and marital status. RESULTS: Reports of condom use at last sex with a regular partner increased by 2.6% points per year [95% confidence interval (CI) 1.5%, 3.7%] for men and 4.1% per year (3.0%, 5.3%) for women. Condom use at last sex with a casual partner was high and did not change significantly over the period for both sexes. There were statistically significant declines in the percentage reporting multiple partnerships in the last year and the point prevalence of concurrency. Trends within subgroups were generally consistent with overall estimates. CONCLUSION: We find no evidence of increased sexual risk-taking following ART availability and protective changes in some behaviours, suggesting that general trends in sexual behaviour are not counter-acting preventive effects of HIV treatment. Continued monitoring of population-level sexual behaviour indicators will be essential to interpret the success of combination-prevention programmes.
Eaton JW, Garnett GP, Takavarasha FR, et al., 2013, Increasing Adolescent HIV Prevalence in Eastern Zimbabwe - Evidence of Long-Term Survivors of Mother-to-Child Transmission?, PLOS One, Vol: 8, ISSN: 1932-6203
Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested thatbetween 2004 and 2007 HIV prevalence amongst males aged 15–17 years in eastern Zimbabwe increased from 1.20% to2.23%, and in females remained unchanged at 2.23% to 2.39%, while prevalence continued to decline in the rest of theadult population. We assess whether the more likely source of the increase in adolescent HIV prevalence is recent sexual HIVacquisition, or the aging of long-term survivors of perinatal HIV acquisition that occurred during the early growth of theepidemic. Using data collected between August 2006 and November 2008, we investigated associations betweenadolescent HIV and (1) maternal orphanhood and maternal HIV status, (2) reported sexual behaviour, and (3) reportingrecurring sickness or chronic illness, suggesting infected adolescents might be in a late stage of HIV infection. HIV-infectedadolescent males were more likely to be maternal orphans (RR = 2.97, p,0.001) and both HIV-infected adolescent males andfemales were more likely to be maternal orphans or have an HIV-infected mother (male RR = 1.83, p,0.001; female RR = 16.6,p,0.001). None of 22 HIV-infected adolescent males and only three of 23 HIV-infected females reported ever having hadsex. HIV-infected adolescents were 60% more likely to report illness than HIV-infected young adults. Taken together, allthree hypotheses suggest that recent increases in adolescent HIV prevalence in eastern Zimbabwe are more likelyattributable to long-term survival of mother-to-child transmission rather than increases in risky sexual behaviour. HIVprevalence in adolescents and young adults cannot be used as a surrogate for recent HIV incidence, and health systemsshould prepare for increasing numbers of long-term infected adolescents.
Hallett TB, Eaton JW, 2013, A Side Door Into Care Cascade for HIV-Infected Patients?, JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol: 63, Pages: S228-S232, ISSN: 1525-4135
Robertson L, Mushati P, Eaton JW, et al., 2013, Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial, LANCET, Vol: 381, Pages: 1283-1292, ISSN: 0140-6736
Robertson L, Mushati P, Eaton JW, et al., 2012, Household-based cash transfer targeting strategies in Zimbabwe: Are we reaching the most vulnerable children?, SOCIAL SCIENCE & MEDICINE, Vol: 75, Pages: 2503-2508, ISSN: 0277-9536
Case KK, Ghys PD, Gouws E, et al., 2012, Understanding the modes of transmission model of new HIV infection and its use in prevention planning, BULLETIN OF THE WORLD HEALTH ORGANIZATION, Vol: 90, Pages: 831-838, ISSN: 0042-9686
Eaton JW, Hallett TB, Epstein H, 2012, What Might be the Impact of Sexual Partnership "Concurrency'' Behavior Change Communication Campaigns?, SEXUALLY TRANSMITTED DISEASES, Vol: 39, Pages: 899-899, ISSN: 0148-5717
Boily M-C, Masse B, Alsallaq R, et al., 2012, HIV Treatment as Prevention: Considerations in the Design, Conduct, and Analysis of Cluster Randomized Controlled Trials of Combination HIV Prevention, PLOS Medicine, Vol: 9, ISSN: 1549-1277
HIV Modelling Consortium Treatment as Prevention Editorial Writing Group, 2012, HIV treatment as prevention: models, data, and questions--towards evidence-based decision-making., PLOS Medicine, Vol: 9, ISSN: 1549-1277
Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different aspects of HIV treatment as prevention with a forward-looking research agenda. Interlocking themes across these articles are discussed in this introduction. We hope that this article, and others in the collection, will provide a foundation upon which greater collaborations between disciplines will be formed, and will afford deeper insights into the key factors involved, to help strengthen the support for evidence-based decision-making in HIV prevention.
Delva W, Eaton JW, Meng F, et al., 2012, HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes, PLOS Medicine, Vol: 9, ISSN: 1549-1277
Until now, decisions about how to allocate ART have largely been based on maximising the therapeutic benefit of ART for patients. Since the results of the HPTN 052 study showed efficacy of antiretroviral therapy (ART) in preventing HIV transmission, there has been increased interest in the benefits of ART not only as treatment, but also in prevention. Resources for expanding ART in the short term may be limited, so the question is how to generate the most prevention benefit from realistic potential increases in the availability of ART. Although not a formal systematic review, here we review different ways in which access to ART could be expanded by prioritising access to particular groups based on clinical or behavioural factors. For each group we consider (i) the clinical and epidemiological benefits, (ii) the potential feasibility, acceptability, and equity, and (iii) the affordability and cost-effectiveness of prioritising ART access for that group. In re-evaluating the allocation of ART in light of the new data about ART preventing transmission, the goal should be to create policies that maximise epidemiological and clinical benefit while still being feasible, affordable, acceptable, and equitable.
Eaton JW, Johnson LF, Salomon JA, et al., 2012, HIV Treatment as Prevention: Systematic Comparison of Mathematical Models of the Potential Impact of Antiretroviral Therapy on HIV Incidence in South Africa, PLOS MEDICINE, Vol: 9, ISSN: 1549-1277
Crea TM, Lombe M, Robertson LA, et al., 2012, Asset ownership among households caring for orphans and vulnerable children in rural Zimbabwe: The influence of ownership on children's health and social vulnerabilities, AIDS Care, Vol: 25, Pages: 126-132, ISSN: 0954-0121
The high prevalence of human immunodeficiency virus/acquired immune deficiency syndrome in sub-Saharan Africa has resulted in a dramatic increase in orphans and vulnerable children (OVC) over the past decade. These children typically rely on extended family networks for support, but the magnitude of the crisis has resulted in traditional familial networks becoming overwhelmed and more economically and socially vulnerable. Previous research consistently demonstrates the positive influence of household asset ownership on children's well-being. Using data from impoverished households caring for OVC in rural Manicaland Province, Zimbabwe, this study explores the influence of household asset ownership on OVC health vulnerability (HV) and social vulnerability (SV). Findings indicate that asset ownership is associated with significantly lower SV, in terms of school attendance and birth registration. Yet, assets do not emerge as a direct influence of OVC HV as measured by disease and chronic illness, although having a chronically ill adult in the household increases HV. These findings suggest that asset ownership, specifically a combination of fixed and movable assets, may offset the influence of other risk factors for children's SV.
Eaton JW, McGrath N, Newell M-L, 2012, Unpacking the recommended indicator for concurrent sexual partnerships, AIDS, Vol: 26, Pages: 1037-1039, ISSN: 0269-9370
Eaton JW, Hallett TB, Garnett GP, 2011, Concurrent Sexual Partnerships and Primary HIV Infection: A Critical Interaction, AIDS AND BEHAVIOR, Vol: 15, Pages: 687-692, ISSN: 1090-7165
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