Treatment to Prevent HIV Transmission in Serodiscordant Couples in Henan, China Public Deposited

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  • March 19, 2019
Creator
  • Smith, M
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Suppressive antiretroviral therapy (ART) can prevent sexual HIV transmission by reducing viral concentration in the blood and genital tract of infected partners. Whether or not this effect can be achieved in the non-trial settings is a matter of debate. Aim 1 assessed the effect of ART on HIV transmission risk between partners in an open cohort of serodiscordant Chinese couples, past analyses of which have resulted in contradictory findings. Public health data collected for disease control purposes was used to analyze seven years of follow-up data for an open cohort of 4916 previously untreated HIV serodiscordant couples. Using marginal structural Cox proportional hazard models to weight for time varying confounding by treatment and censoring, we found that ART reduced the risk of HIV transmission by 55% (95% CI, 0.23-0.88). However graphical plots of weighted survival curves and stratified analyses by time period indicated a lack of effect before 2009 (HR, 1.27, 95% CI, 0.39-4.11) followed by a much greater effect from 2009 onward (HR, 0.36, 95% CI, 0.19-0.68). This periodicity coincides with a phase of massive scale up and introduction of second line antiretrovirals in China's free ART program, though the protective effect did not appear to vary by specific type of ART regimen. In Aim 2 we used a data from the subset of the same couples who ever received ART in the course of follow-up (N=3939) to assess the impact of distance to the HIV care center and patient load per clinician on HIV transmission risk. Higher patient load (over 100 patients per clinician) was significantly associated with higher risk of HIV transmission (HR=1.24, 95% CI, 1.27-4.03), particularly among those assigned to village HIV care centers (HR=2.26, 95% CI, 1.27-4.03). Adjusted Cox proportional hazards models found that living farther (>10 kilometers, km) from the clinic was associated with HIV transmission risk (HR=1.18, 95% CI, 0.44-3.1). We hypothesize that motivation for care seeking and minimum thresholds for distances willing to be traveled may differ by the tier of designated HIV care centers.
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  • In Copyright
Advisor
  • Pettifor, Audrey
  • Weir, Sharon
  • Cohen, Myron
  • Henderson, Gail
  • Miller, William
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2014
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  • Chapel Hill, NC
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  • This item is restricted from public view for 1 year after publication.
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