Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study

dc.contributor.authorvan Loggerenberg, Francoisen_ZA
dc.contributor.authorMlisana, Kolekaen_ZA
dc.contributor.authorWilliamson, Carolynen_ZA
dc.contributor.authorAuld, Sara Cen_ZA
dc.contributor.authorMorris, Lynnen_ZA
dc.contributor.authorGray, Clive Men_ZA
dc.contributor.authorKarim, Quarraisha Abdoolen_ZA
dc.contributor.authorGrobler, Annekeen_ZA
dc.contributor.authorBarnabas, Nomampondoen_ZA
dc.contributor.authorIriogbe, Ituaen_ZA
dc.date.accessioned2015-12-28T06:47:47Z
dc.date.available2015-12-28T06:47:47Z
dc.date.issued2008en_ZA
dc.description.abstractObjectives To describe the baseline demographic data, clinical characteristics and HIV-incidence rates of a cohort at high risk for HIV infection in South Africa as well as the challenges experienced in establishing and maintaining the cohort. Methodology/Principle FINDINGS: Between August 2004 and May 2005 a cohort of HIV-uninfected women was established for the CAPRISA 002 Acute Infection Study, a natural history study of HIV-1 subtype C infection. Volunteers were identified through peer-outreach. The cohort was followed monthly to determine HIV infection rates and clinical presentation of early HIV infection. Risk reduction counselling and male and female condoms were provided. After screening 775 individuals, a cohort of 245 uninfected high-risk women was established. HIV-prevalence at screening was 59.6% (95% CI: 55.9% to 62.8%) posing a challenge in accruing HIV-uninfected women. The majority of women (78.8%) were self-identified as sex-workers with a median of 2 clients per day. Most women (95%) reported more than one casual sexual partner in the previous 3 months (excluding clients) and 58.8% reported condom use in their last sexual encounter. Based on laboratory testing, 62.0% had a sexually transmitted infection at baseline. During 390 person-years of follow-up, 28 infections occurred yielding seroincidence rate of 7.2 (95% CI: 4.5 to 9.8) per 100 person-years. Despite the high mobility of this sex worker cohort retention rate after 2 years was 86.1%. High co-morbidity created challenges for ancillary care provision, both in terms of human and financial resources. Conclusions/Significance Challenges experienced were high baseline HIV-prevalence, lower than anticipated HIV-incidence and difficulties retaining participants. Despite challenges, we have successfully accrued this cohort of HIV-uninfected women with favourable retention, enabling us to study the natural history of HIV-1 during acute HIV-infection. Our experiences provide lessons for others establishing similar cohorts, which will be key for advancing the vaccine and prevention research agenda in resource-constrained settings.en_ZA
dc.identifier.apacitationvan Loggerenberg, F., Mlisana, K., Williamson, C., Auld, S. C., Morris, L., Gray, C. M., ... Iriogbe, I. (2008). Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study. <i>PLoS One</i>, http://hdl.handle.net/11427/16051en_ZA
dc.identifier.chicagocitationvan Loggerenberg, Francois, Koleka Mlisana, Carolyn Williamson, Sara C Auld, Lynn Morris, Clive M Gray, Quarraisha Abdool Karim, Anneke Grobler, Nomampondo Barnabas, and Itua Iriogbe "Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study." <i>PLoS One</i> (2008) http://hdl.handle.net/11427/16051en_ZA
dc.identifier.citationvan Loggerenberg, F., Mlisana, K., Williamson, C., Auld, S. C., Morris, L., Gray, C. M., ... & Karim, S. A. (2008). Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study. PloS one, 3(4), e1954. doi:10.1371/journal.pone.0001954en_ZA
dc.identifier.ris TY - Journal Article AU - van Loggerenberg, Francois AU - Mlisana, Koleka AU - Williamson, Carolyn AU - Auld, Sara C AU - Morris, Lynn AU - Gray, Clive M AU - Karim, Quarraisha Abdool AU - Grobler, Anneke AU - Barnabas, Nomampondo AU - Iriogbe, Itua AB - Objectives To describe the baseline demographic data, clinical characteristics and HIV-incidence rates of a cohort at high risk for HIV infection in South Africa as well as the challenges experienced in establishing and maintaining the cohort. Methodology/Principle FINDINGS: Between August 2004 and May 2005 a cohort of HIV-uninfected women was established for the CAPRISA 002 Acute Infection Study, a natural history study of HIV-1 subtype C infection. Volunteers were identified through peer-outreach. The cohort was followed monthly to determine HIV infection rates and clinical presentation of early HIV infection. Risk reduction counselling and male and female condoms were provided. After screening 775 individuals, a cohort of 245 uninfected high-risk women was established. HIV-prevalence at screening was 59.6% (95% CI: 55.9% to 62.8%) posing a challenge in accruing HIV-uninfected women. The majority of women (78.8%) were self-identified as sex-workers with a median of 2 clients per day. Most women (95%) reported more than one casual sexual partner in the previous 3 months (excluding clients) and 58.8% reported condom use in their last sexual encounter. Based on laboratory testing, 62.0% had a sexually transmitted infection at baseline. During 390 person-years of follow-up, 28 infections occurred yielding seroincidence rate of 7.2 (95% CI: 4.5 to 9.8) per 100 person-years. Despite the high mobility of this sex worker cohort retention rate after 2 years was 86.1%. High co-morbidity created challenges for ancillary care provision, both in terms of human and financial resources. Conclusions/Significance Challenges experienced were high baseline HIV-prevalence, lower than anticipated HIV-incidence and difficulties retaining participants. Despite challenges, we have successfully accrued this cohort of HIV-uninfected women with favourable retention, enabling us to study the natural history of HIV-1 during acute HIV-infection. Our experiences provide lessons for others establishing similar cohorts, which will be key for advancing the vaccine and prevention research agenda in resource-constrained settings. DA - 2008 DB - OpenUCT DO - 10.1371/journal.pone.0001954 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2008 T1 - Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study TI - Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study UR - http://hdl.handle.net/11427/16051 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16051
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0001954
dc.identifier.vancouvercitationvan Loggerenberg F, Mlisana K, Williamson C, Auld SC, Morris L, Gray CM, et al. Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection study. PLoS One. 2008; http://hdl.handle.net/11427/16051.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2008 van Loggerenberg et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherSexually transmitted diseasesen_ZA
dc.subject.otherHIV-1en_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherHIV preventionen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleEstablishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 acute infection studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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