Temporal evolution of HIV sero-discordancy patterns among stable couples in sub-Saharan Africa.

• Main Authors: Susanne F Awad, Hiam Chemaitelly, Laith J Abu-Raddad
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2018-01-01
• Series: PLoS ONE
• Online Access: http://europepmc.org/articles/PMC5927442?pdf=render

Objective was to examine the temporal variation of HIV sero-discordancy in select representative countries (Kenya, Lesotho, Mali, Niger, Tanzania, and Zimbabwe) in sub-Saharan Africa at different HIV epidemic scales. A sero-discordant couple is defined as a stable couple (SC) in which one partner is HIV-positive while the other is HIV-negative.A deterministic compartmental mathematical model was constructed to describe HIV transmission dynamics. The model was pair-based, that is explicitly modeling formation of SCs and infection dynamics in both SCs and in single individuals. The model accommodated for different forms of infection statuses in SCs. Using population-based nationally-representative epidemiologic and demographic input data, historical (1980-2014) and future (2015-2030) trends of sero-discordancy and other demographic and epidemiologic indicators were projected throughout HIV epidemic phases.As the epidemics emerged, about 90% of SCs affected by HIV were sero-discordant. This proportion declined to 45%-88% at epidemic peak and stabilized as the epidemics started their natural decline. The largest reductions in sero-discordancy were in high HIV-prevalence countries. As the epidemics further declined with antiretroviral therapy (ART) scale-up, the proportion of sero-discordant couples among HIV-affected couples was projected to increase to 70%-92% by 2030. The proportion of sero-discordant couples among all SCs increased as the epidemics emerged and evolved, then peaked at 2%-20% as the epidemics peaked, and then declined as the epidemics declined to reach 0.3%-16% by 2030.Sero-discordancy patterns varied with the evolution of the epidemics, and were affected by both epidemic phase and scale. The largest variations were found in high HIV-prevalence countries. The fraction of stable couples that are sero-discordant, as opposed to being sero-concordant positive, was projected to increase with ART scale-up and further HIV incidence decline over the coming two decades. These findings inform strategic planning and resource allocation for interventions among sero-discordant couples.