Publications
159 results found
Crea TM, Reynolds AD, Sinha A, et al., 2015, Effects of cash transfers on Children's health and social protection in Sub-Saharan Africa: differences in outcomes based on orphan status and household assets, BMC Public Health, Vol: 15, ISSN: 1471-2458
BackgroundUnconditional and conditional cash transfer programmes (UCT and CCT) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS (OVC). We address the gap in current understanding about the extent to which household-based cash transfers differentially impact individual children’s outcomes, according to risk or protective factors such as orphan status and household assets.MethodsData were obtained from a cluster-randomised controlled trial in eastern Zimbabwe, with random assignment to three study arms – UCT, CCT or control. The sample included 5,331 children ages 6-17 from 1,697 households. Generalized linear mixed models were specified to predict OVC health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Models included child-level risk factors (age, orphan status); household risk factors (adults with chronic illnesses and disabilities, greater household size); and household protective factors (including asset-holding). Interactions were systematically tested.ResultsOrphan status was associated with decreased likelihood for birth registration, and paternal orphans and children for whom both parents’ survival status was unknown were less likely to attend school. In the UCT arm, paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans. Effects of study arms on outcomes were not moderated by any other risk or protective factors. High household asset-holding was associated with decreased likelihood of child’s chronic illness and increased birth registration and school attendance, but household assets did not moderate the effects of cash transfers on risk or protective factors.ConclusionOrphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. UCT and CCT each produced direct effects on children’s social protection
McGrath N, Eaton JW, Newell M-L, et al., 2015, Migration, sexual behaviour, and HIV risk: a general population cohort in rural South Africa, The Lancet HIV, Vol: 2, Pages: e252-e259, ISSN: 2352-3018
BackgroundIncreased sexual risk behaviour and HIV prevalence have been reported in migrants compared with non-migrants in sub-Saharan Africa. We investigated the association of residential and migration patterns with sexual HIV risk behaviours and HIV prevalence in an open, general population cohort in rural KwaZulu-Natal, South Africa.MethodsIn a mainly rural demographic surveillance area in northern KwaZulu-Natal, South Africa, we collected longitudinal demographic, migration, sexual behaviour, and HIV status data through household surveillance twice per year and individual surveillance once per year. All resident household members and a sample of non-resident household members (stratified by sex and migration patterns) were eligible for participation. Participants reported sexual risk behaviours, including data for multiple, concurrent, and casual sexual partners and condom use, and gave a dried blood spot sample via fingerprick for HIV testing. We investigated population-level differences in sexual HIV risk behaviours and HIV prevalence with respect to migration indicators using logistic regression models.FindingsBetween Jan 1, 2005, and Dec 31, 2011, the total eligible population at each surveillance round ranged between 21 129 and 22 726 women (aged 17–49 years) and between 20 399 and 22 100 men (aged 17–54 years). The number of eligible residents in any round ranged from 24 395 to 26 664 and the number of eligible non-residents ranged from 17 002 to 18 891 between rounds. The stratified sample of non-residents included between 2350 and 3366 individuals each year. Sexual risk behaviours were significantly more common in non-residents than in residents for both men and women. Estimated differences in sexual risk behaviours, but not HIV prevalence, varied between the migration indicators: recent migration, mobility, and migration type. HIV prevalence was significantly increased in current residents with a recent history of migration compared with oth
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
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- Citations: 14
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
Chandrasekaran L, Davies B, Eaton JW, et al., 2014, Evaluation of diagnosed incidence rate as a measure of performance: an ecological study of England's national chlamydia screening programme, European Public Health Science Conference
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
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- Citations: 37
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.
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
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
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- Citations: 12
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
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- Citations: 13
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
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- Citations: 81
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, The Lancet Global Health, Vol: 2, Pages: E23-E34, ISSN: 2214-109X
BackgroundNew WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage.MethodsWe used several independent mathematical models in four settings—South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)—to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per μL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost effective if the cost per DALY averted was less than the country's 2012 per-head gross domestic product (GDP; South Africa: $8040; Zambia: $1425; India: $1489; Vietnam: $1407) and cost effective if the cost per DALY averted was less than three times the per-head GDP.FindingsIn South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per &
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
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- Citations: 10
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
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- Citations: 33
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
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- Citations: 21
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
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- Citations: 54
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
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- Citations: 84
Pufall EL, Nyamukapa C, Eaton JW, et al., 2013, HIV IN CHILDREN IN A GENERAL POPULATION SAMPLE IN SOUTHERN AFRICA: PREVALENCE, CAUSES AND EFFECTS, SEXUALLY TRANSMITTED INFECTIONS, Vol: 89, Pages: A163-A163, ISSN: 1368-4973
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- Citations: 1
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
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- Citations: 140
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
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- Citations: 9
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
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- Citations: 44
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
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- Citations: 1
McGrath N, Eaton JW, Tanser F, et al., 2012, Sexual behaviour trends by gender in a rural South African population-based cohort during the era of scaled-up access to VCT and ART, 2005-2010, Publisher: JOHN WILEY & SONS LTD, Pages: 119-120
Robertson L, Mushati P, Eaton JW, et al., 2012, Conditional cash transfers improve birth registration and school attendance amongst orphans and vulnerable children in Manicaland, Zimbabwe, JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, Vol: 15, Pages: 158-159
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- Citations: 3
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
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