Kharsany, A.B., Frohlich, J.A., Yende-Zuma, N., et al. Journal of Acquired Immune Deficiency Syndromes (November 2015), 70 (3): 289–295, doi: 10.1097/QAI.0000000000000761.
This study assessed HIV prevalence trends in 5,075 pregnant women in the rural Vulindlela sub-district of KwaZulu-Natal, South Africa following the introduction and scale-up of antiretroviral therapy (ART), and described risk factors associated with HIV transmission. The authors conducted cross-sectional surveys from October through November of each year from 2001 to 2013 among pregnant women presenting at primary health care clinics for their first prenatal care visit. The time periods 2001 to 2003 were defined as pre-ART, 2004 to 2008 as early ART, and 2009 to 2013 as contemporary ART rollout, to correspond with the substantial scale-up of ART program. The authors reported that overall, HIV prevalence increased during each period (35.3%, 39.0%, and 39.3%, respectively). However, age-stratified analysis revealed nuances. Among teenage women (<20 years), HIV prevalence declined during these same periods (22.5%, 20.7%, and 17.2%), while increasing significantly in women 30 years and older. Moreover, teenage girls with male partners aged 20–24 and >25 years had a 1.7-fold and 3-fold higher HIV prevalence, respectively. The authors concluded that targeted interventions for pregnant women, especially for those in age-disparate relationships, are needed to change the trajectory of this HIV epidemic.