Establishing a cohort at high risk of HIV infection in South Africa: challenges and experiences of the CAPRISA 002 Acute Infection Study.
Date
2007
Journal Title
Journal ISSN
Volume Title
Publisher
Plos.
Abstract
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.
Description
Keywords
Medicine--Research--South Africa., HIV infections--Research., AIDS (Disease)--Research-- South Africa.
Citation
Van Loggerenberg F., et al. 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.0001954