Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 1;90(2):115-123.
doi: 10.1097/QAI.0000000000002927. Epub 2022 Feb 7.

The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019

Leigh F Johnson  1 , Gesine Meyer-Rath  2   3   4 , Rob E Dorrington  5 , Adrian Puren  6 , Thapelo Seathlodi  1 , Khangelani Zuma  7 , Ali Feizzadeh  8
Affiliations

The Effect of HIV Programs in South Africa on National HIV Incidence Trends, 2000-2019

Leigh F Johnson et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Recent studies have shown HIV incidence declines at a population level in several African countries. However, these studies have not directly quantified the extent to which incidence declines are attributable to different HIV programs.

Methods: We calibrated a mathematical model of the South African HIV epidemic to age- and sex-specific data from antenatal surveys, household surveys, and death registration, using a Bayesian approach. The model was also parameterized using data on self-reported condom use, voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral treatment (ART). Model estimates of HIV incidence were compared against the incidence rates that would have been expected had each program not been implemented.

Results: The model estimated incidence in 15-49 year olds of 0.84% (95% CI: 0.75% to 0.96%) at the start of 2019. This represents a 62% reduction (95% CI: 55% to 66%) relative to 2000, a 47% reduction (95% CI: 42% to 51%) relative to 2010, and a 73% reduction (95% CI: 68% to 77%) relative to the incidence that would have been expected in 2019 in the absence of any interventions. The reduction in incidence in 2019 because of interventions was greatest for ART and condom promotion, with VMMC and behavior change after HIV testing having relatively modest impacts. HIV program impacts differed significantly by age and sex, with condoms and VMMC having greatest impact in youth, and overall incidence reductions being greater in men than in women.

Conclusions: HIV incidence in South Africa has declined substantially since 2000, with ART and condom promotion contributing most significantly to this decline.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

    1. Vandormael A, Akullian A, Siedner M, et al. Declines in HIV incidence among men and women in a South African population-based cohort. Nat Commun. 2019;10:5482.
    1. Borgdorff MW, Kwaro D, Obor D, et al. HIV incidence in western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis. Lancet HIV. 2018;5:e241–e249.
    1. Grabowski MK, Serwadda DM, Gray RH, et al. HIV prevention efforts and incidence of HIV in Uganda. N Engl J Med. 2017;377:2154–2166.
    1. Joshi K, Lessler J, Olawore O, et al. Declining HIV incidence in sub-Saharan Africa: a systematic review and meta-analysis of empiric data. J Int AIDS Soc. 2021;24:e25818.
    1. Akullian A, Morrison M, Garnett GP, et al. The effect of 90-90-90 on HIV-1 incidence and mortality in eSwatini: a mathematical modelling study. Lancet HIV. 2020;7:e348–e358.

Publication types

Substances