The impact of the HIV/AIDS pandemic on societies is without precedent in recorded human history. Globally, 40 million people are living with HIV/AIDS, the vast majority in sub-Saharan Africa. A prerequisite for the development and implementation of prevention interventions is an understanding of who is at risk and why. Many characteristics of the individual, the community they are from and the infection itself contribute to determining the risk of exposure and acquisition and multiple causal pathways exist linking social, demographic, economic, cultural and behavioural variables. Whilst many advances have been made in understanding the spread of HIV from studies of individual risk factors in a diverse range of populations, much is still unknown about why populations have experienced different epidemics, and what the drivers of high risk are compared with variables that simply correlate with risk. The project will use a multi-level framework to better understand the causal pathways of HIV infection (both in terms of acquisition and transmission of infection) in a rural South African setting where population-based surveys have measured HIV prevalence at >50% in some age-groups.
The research aims to identify and quantify important environmental, community, household and individual-level determinants of HIV incidence and prevalence to inform intervention strategies. Particular emphasis is placed at the level of the local community which is seen as being vital both to understanding the spread of the epidemic and to effective prevention efforts. Project narrative To be able to implement effective interventions a greater understanding of the complex multi-level nature of the HIV epidemic is necessary. The proposed research will lead to a greater understanding of causal pathways of HIV infection by identifying and quantifying important environmental, community, household and individual-level determinants of HIV infection. This information can be used to guide effective prevention efforts.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HOP-T (50))
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Newcomer, Susan
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University of Kwazulu-Natal
South Africa
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Tanser, Frank; de Oliveira, Tulio; Maheu-Giroux, Mathieu et al. (2014) Concentrated HIV subepidemics in generalized epidemic settings. Curr Opin HIV AIDS 9:115-25
Ross, Eric; Tanser, Frank; Pei, Pamela et al. (2014) The impact of the 2013 WHO antiretroviral therapy guidelines on the feasibility of HIV population prevention trials. HIV Clin Trials 15:185-98
Ardington, Cally; Bärnighausen, Till; Case, Anne et al. (2014) The Economic Consequences of AIDS mortality in South Africa. J Dev Econ 111:48-60
Raifman, Julia; Chetty, Terusha; Tanser, Frank et al. (2014) Preventing unintended pregnancy and HIV transmission: effects of the HIV treatment cascade on contraceptive use and choice in rural KwaZulu-Natal. J Acquir Immune Defic Syndr 67 Suppl 4:S218-27
Bor, Jacob; Moscoe, Ellen; Mutevedzi, Portia et al. (2014) Regression discontinuity designs in epidemiology: causal inference without randomized trials. Epidemiology 25:729-37
Vandormael, Alain; Newell, Marie-Louise; Bärnighausen, Till et al. (2014) Use of antiretroviral therapy in households and risk of HIV acquisition in rural KwaZulu-Natal, South Africa, 2004–12: a prospective cohort study. Lancet Glob Health 2:e209-15
Harling, Guy; Newell, Marie-Louise; Tanser, Frank et al. (2014) Do age-disparate relationships drive HIV incidence in young women? Evidence from a population cohort in rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 66:443-51
Mishra, Sharmistha; Mountain, Elisa; Pickles, Michael et al. (2014) Exploring the population-level impact of antiretroviral treatment: the influence of baseline intervention context. AIDS 28 Suppl 1:S61-72
Bärnighausen, Till; Eyal, Nir; Wikler, Daniel (2014) HIV treatment-as-prevention research at a crossroads. PLoS Med 11:e1001654
Tanser, Frank; Jones, Kyle G; Viljoen, Johannes et al. (2013) Human papillomavirus seropositivity and subsequent risk of HIV acquisition in rural South African women. Sex Transm Dis 40:601-6

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