INTEGRATED ACTIVITY FLAG:

This activity also relates to CAPRISA's activities in ARV Services (#7497), ARV Drugs (#7498) and Counseling and Testing (#7496). This partner may benefit from the Partnership for Supply Chain Management ARV Drugs activity (#7935), which will explore current pain and symptom management practices, drug availability and cost, and provide recommendations.

SUMMARY:

Activities are carried out to provide clinical, spiritual and psychosocial support to the HIV-infected patient and family affected by the disease at two established treatment sites in KwaZulu-Natal. Also included is TB treatment for TB/HIV co-infected patients at the eThekwini (Durban) site.

BACKGROUND:

CAPRISA was established in 2002 as a not for profit AIDS research organization by five major partner institutions: University of KwaZulu-Natal, University of Cape Town, University of Western Cape, National Institute for Communicable Diseases, and Columbia University. The headquarters of CAPRISA are located in the Doris Duke Medical Research Institute at the Nelson R Mandela School of Medicine, University of KwaZulu-Natal. The PEPFAR-funded CAPRISA AIDS Treatment (CAT) Program was initially started as a supplemental effort to deal with the large volume of HIV-infected clients that were screened out of CAPRISA's other research studies. It has since evolved into one of the pillars of CAPRISA and is evidence of the ongoing commitment to provide comprehensive services to communities. The CAT Program was initiated in June 2004 and currently provides an integrated package of prevention and treatment services. The program also provides an innovative method of providing ART by integrating the tuberculosis (TB) and HIV care as well as counseling and testing, family planning, sexually transmitted infections (STI) treatment, prophylaxis and treatment for opportunistic infections (OIs), and other HIV associated conditions at both a rural and urban site.

The CAPRISA eThekwini Clinical Research Site is attached to the Prince Cyril Zulu Communicable Disease Clinic (CDC) which is a large local government clinic for the diagnosis and treatment of STIs and TB, for which it provides free treatment. The HAART provision at this clinic integrates TB and HIV care into the existing TB directly observed therapy, short course (DOTS) programs. This allows for the opportunity to initiate HIV care and HAART for patients identified as HIV-infected during TB treatment as well as to be able to continue such management for those who develop TB during HIV treatment.

The CAPRISA Vulindlela Clinical Research Site is a rural facility located about 150 km west of Durban in KwaZulu-Natal. The Vulindlela district is home to about 500,000 residents whose main access to health care is at seven primary health care (PHC) clinics that provide comprehensive services. The CAT Program at Vulindlela is an entirely rural nurse-driven service with doctors available for the initial eligibility assessment and for advice and referral.

At the Vulindlela Site, by the end of June 2006, 2033 people have been tested for HIV and 668 people had been initiated on ART. At the eThekwini Site, which was initiated in September 2004, 444 people had been initiated on ART by the end of June 2006 and 1765 people were in care, but not on ART.

ACTIVITIES AND EXPECTED RESULTS:

The CAT Program offers extensive counseling and education around HIV, wellness maintenance, disclosure, and HIV treatment adherence. Patients are also encouraged to bring partners in for testing. Women of child-bearing age are referred for pap smears, pregnancy testing and family planning. At the eThekwini Site the clinic is open Monday to Friday and is operated by 3 full-time doctors, 2 part-time doctors, 4 nurses, 3 counselors, an assistant and a pharmacist. Clients from throughout the greater Durban area who may have TB are routinely evaluated and are offered counseling and HIV testing. HIV-negative patients are invited to participate in ongoing prevention activities at both facilities.

Patients who test positive for HIV are offered HIV specific care through the CAT Program. Attention will be given to increasing the gender equity in the HIV and AIDS programs and increasing male involvement in the program (key legislative area).

HIV clinical care services that are offered include Bactrim prophylaxis, routine screening for OIs, via clinical examination, and blood, urine or sputum testing where required. The CAT project has the capacity to treat commonly occurring OIs at site level and these include pulmonary and extrapulmonary TB, candidiasis, pneumonia, gastro-enteritis, and other respiratory infections. The CAT project also accesses and supplies drugs such as diflucan. Clients are referred to tertiary level facilities if they require investigation and inpatient management out of the scope of the clinic management.

The CAT Program offers extensive counseling and education around HIV, wellness maintenance, disclosure, and HIV treatment adherence. Patients are also encouraged to bring partners in for testing. In addition counselors liaise with social welfare departments and other community-based organizations (CBOs) to assist in enhancing social support for patients.

The CAT program in Vulindlela aims to address issues of stigma and discrimination and is linked to an Oxfam-funded project which addresses stigma and discrimination (key legislative area) in the community. The CAT program provides support for disclosing to family members and assists patients in obtaining disability grants. CAPRISA has an extensive community program which supports and facilitates community involvement and informed participation for all CAPRISA projects. Comprehensive services are provided to HIV-infected participants where appropriate. Community-based care includes referral for psychological support, stigma reduction strategies, adherence support for OI medications and ART, pre and post-test counseling for HIV infection, implementation of ARV treatment, prophylaxis for OIs, management of OIs, adverse events and severe adverse events. Appropriate referral to clinics takes place when needed.

With FY 2007 funding the CAT Program will be continued and expanded at the two established sites; the rural primary care clinic in Vulindlela and the eThekwini Clinical Research Site based at the Prince Cyril Zulu Communicable Disease Centre (CDC) in Durban.

These results contribute to the PEPFAR 2-7-10 goals by providing facility-based HIV-related palliative care to HIV-infected individuals by providing clinical prophylaxis and treatment for TB/HIV co-infected patients prior to initiation of ARVs.

INTEGRATED ACTIVITY FLAG:

This CAPRISA activity also relates to Basic Health Care and Support (#7499) and ARV Services (#7497)

SUMMARY:

Activities are carried out to support comprehensive counseling and testing (CT) services in the rural area of Vulindlela and the CAPRISA eThekwini Clinical Research Site located next to the tuberculosis (TB) clinic in Durban. In addition, activities will involve the continuation of expanding CT among two high-risk groups at two established treatment sites in KwaZulu Natal. These high-risk groups include sexually transmitted infection (STI) patients, and an adolescent population in rural Vulindlela. CAPRISA follows the National Department of Health's recommended algorithm for rapid HIV testing.

The primary emphasis area for this activity is human resources, with minor areas on community mobilization and on information, education and communication. Specific target populations include children and youth (non-OVC), out-of-school youth and men and women of reproductive age.

BACKGROUND:

CAPRISA was established in 2002 as a not-for-profit AIDS research organization by five major partner institutions: University of KwaZulu-Natal, University of Cape Town, University of Western Cape, National Institute for Communicable Diseases (NICD), and Columbia University. The headquarters of CAPRISA are located in the Doris Duke Medical Research Institute at the Nelson R Mandela School of Medicine, University of KwaZulu-Natal. The PEPFAR-funded CAPRISA AIDS Treatment (CAT) Program was initially started as a supplemental effort to deal with the large volume of HIV positive clients that were screened out of CAPRISA's other research studies.

The existing counseling and testing services at two treatment sites will be continued with FY 2007 funding. The strength of the current CAT program is that it provides an integrated package of prevention and treatment services and provides an innovative method of providing antiretroviral treatment (ART) by integrating the TB and HIV care at both an urban and rural site. In 2006 CAPRISA began offering counseling and testing services to two high-risk populations in order to enhance the uptake of counseling and testing in these populations. This service has enabled the CAT program to create a synergy between treatment and prevention services while simultaneously identifying high-risk HIV individuals to enhance their prevention potential through ART.

ACTIVITIES AND EXPECTED RESULTS:

ACTIVITY 1: Voluntary Counseling and Testing

The voluntary counseling and testing (VCT) services will be continued in the rural primary care clinic in Vulindlela and the eThekwini Clinical Research Site based at the Prince Cyril Zulu Communicable Disease Centre (CDC) in Durban. All VCT is currently offered in conjunction with an NGO, known as Open Door, to patients attending these two facilities. The VCT that is offered includes prevention education and condom distribution.

ACTIVITY 2: Provider-Initiated Counseling and Testing

Provider-initiated counseling and testing will be offered to all STI patients at the Prince Cyril Zulu CDC which is a large local government clinic for the diagnosis and treatment of STIs, for which it provides free treatment. Annually, approximately 4,000 cases of STIs are treated at this clinic, with an average of about 135 STI patients per day. Given the high HIV prevalence of 63% in this group, these patients are a key risk group for acquiring and transmitting HIV. All patients attending the STI clinic are routinely offered counseling and testing by the STI nurses. Male and female patients seeking STI care at the clinic are provided with group counseling and prevention messages and offered individual HIV testing. Those who test HIV positive are individually post-test counseled and referred for ongoing supportive counseling and medical care in the CAPRISA facility.

ACTIVITY 3: Routine Testing for Adolescents

The adolescent population in rural Vulindlela is also targeted by this program. In South Africa adolescents, and particularly young women, are at high risk of acquiring HIV. Adolescents in the area, primarily those utilizing the primary healthcare services for antenatal, family planning or STI services are routinely offered counseling and testing. The counseling and testing is coordinated with other programs and projects in the area. In addition, youth peer educators have been integrated within this program.

Thus far, ART rollout activities have generally been targeting those most accessible i.e., health service attendees and have not met the challenge of using ART provision to enhance prevention, especially prevention in HIV-infected individuals. In FY 2007 CAPRISA plans to continue targeting the two high-risk groups for both client and provider-initiated counseling and testing. The expanded counseling and testing program will continue to exploit the synergy that exists between the promotion of counseling and testing and availability of high quality HIV care to enhance both prevention and treatment in TB patients, STI patients and adolescents. HIV-infected persons identified will be referred to the CAT Program for follow-up treatment and care. HIV negative persons will be referred to other CAPRISA, government or NGO prevention programs. Importantly, this strategy begins to address the ethical dilemma of how scarce resources for HIV can be used effectively by focusing on high-risk groups and utilizing access to ART to enhance counseling and testing for treatment and prevention.

During FY 2007 the expanded counseling and testing service will not require additional counselors or field workers. The counselors and fieldworkers will, however, receive ongoing training in counseling with role-playing to ensure high quality counseling and testing. As part of an internal quality assurance process, counseling sessions are often critiqued by a senior counselor, and training is based on common areas of deficiencies identified. A constant review process has been established to reflect of reasons for refusal of uptake of VCT, and strategies have been implemented to address common reasons for refusal e.g. high refusal rate for testing was initially seen by male patients counseled by female counselors, and this was addressed by having male counselors on hand to see male patients. In addition, regular debriefing sessions are scheduled to allow counselors suffering from burnout to distress and support one another.

These results contribute to the PEPFAR 2-7-10 goals by improving access to and quality of CT services in order to identify HIV positive persons and increase the number of persons receiving ARV services in three high risk groups; TB patients, STI patients and adolescents.

INTEGRATED ACTIVITY FLAG:

This activity also relates to CAPRISA's activities in palliative care (7499) , ARV services (7497) and counseling and testing (7496).

SUMMARY:

Activities are carried out to continue the provision of antiretroviral drugs to patients already initiated on treatment and to expand access to treatment to additional patients at two established treatment sites in KwaZulu-Natal.

BACKGROUND:

CAPRISA was established in 2002 as a not for profit AIDS research organization by five major partner institutions; University of KwaZulu-Natal, University of Cape Town, University of Western Cape, National Institute for Communicable Diseases, and Columbia University. The headquarters of CAPRISA are located in the Doris Duke Medical Research Institute at the Nelson R Mandela School of Medicine, University of KwaZulu-Natal. The PEPFAR-funded CAPRISA AIDS Treatment (CAT) Program was initially started as a supplemental effort to deal with the large volume of HIV positive clients that were screened out of CAPRISA's other research studies. The current CAT Program provides an integrated package of prevention and treatment services and provides an innovative method of providing ART by integrating the TB and HIV care. The CAPRISA eThekwini Clinical Research Site is attached to the Prince Cyril Zulu Communicable Disease Clinic (CDC) which is a large local government clinic for the diagnosis and treatment of STIs and TB, for which it provides free treatment. The HAART provision at this clinic integrates TB and HIV care into the existing TB directly observed therapy (DOT) programs. This allows for the opportunity to initiate HIV care and HAART for patients identified as HIV infected during TB treatment as well as to be able to continue such management for those who develop TB during HIV treatment.

The CAPRISA Vulindlela Clinical Research Site is a rural facility located about 150 km west of Durban, KwaZulu-Natal. The Vulindlela district is home to about half a million residents whose main access to health care is at seven primary health care (PHC) clinics that provide comprehensive services. The CAT Program at Vulindlela is an entirely rural nurse-driven service with doctors available for the initial eligibility assessment and for advice and referral.

ACTIVITIES AND EXPECTED RESULTS:

At the eThekwini Site, all patients in the CAT Program with CD4 counts < 200 see a clinician monthly for clinical and laboratory follow-up. These patients are initiated on ART following a clinical and laboratory safety assessment, as well as 3 or more intensive sessions of adherence support counseling. At the eThekwini Site, a once daily regimen of ddI, 3TC, and EFV is used (as per South African treatment guidelines and protocols). The funding to purchase the ARV drugs for patients at the eThekwini Site are from the Global Fund to fight AIDS, Tuberculosis (TB) and Malaria. All other aspects of care are covered by PEPFAR funds.

In Vulindlela, the first line regime includes: Lamivudine, Stavudine and NVP and second line therapy includes: EFV, AZT, 3TC and ABC. PEPFAR funds are used for the purchase of these drugs. Generic medications purchased comply with the South African requirement of FDA approval as well as approval from the Medicines Control Council of South Africa.

All ARV drug orders are placed by the senior Research Pharmacist, based at the CAPRISA offices in Durban. Bulk stocks are received at the central CAPRISA pharmacy in Durban and then distributed to the sites as appropriate. The senior Research Pharmacist ensures that sufficient study product is always on hand for at least 2 months' anticipated usage.

These results contribute to the PEPFAR 2-7-10 goals by ensuring that there is an uninterrupted supply of drugs for persons initiated on ART.

INTEGRATED ACTIVITY FLAG:

This activity also relates to CAPRISA's activities in Basic Health Care and Support (#7499), ARV Drugs (#7498) and Counseling and Testing (#7496).

SUMMARY:

Activities are carried out with FY 2007 funding to continue the provision of HIV care and antiretroviral treatment (ART) services to patients already initiated on treatment and to expand access to treatment at two established treatment sites in KwaZulu-Natal. The major emphasis area is human resources, with minor emphasis on commodity procurement, infrastructure, and local organization capacity development. The target population is people living with HIV (PLHIV).

BACKGROUND:

CAPRISA was established in 2002 as a not for profit AIDS research organization by five major partner institutions; University of KwaZulu-Natal, University of Cape Town, University of Western Cape, National Institute for Communicable Diseases, and Columbia University. The headquarters of CAPRISA are at the University of KwaZulu-Natal. The PEPFAR-funded CAPRISA AIDS Treatment (CAT) Program was initially started as a supplemental effort to deal with the large volume of HIV-infected adult clients that were screened out of CAPRISA's other research studies. The current CAT Program provides an integrated package of prevention and treatment services and provides an innovative method of providing ART by integrating TB and HIV care. The ART provision at the CAPRISA eThekwini clinical research site integrates TB and HIV care into the existing TB directly observed therapy (DOT) programs. This allows for the opportunity to initiate HIV care and ART for patients identified as HIV infected during TB treatment as well as to be able to continue such management for those who develop TB during HIV treatment.

The CAPRISA Vulindlela clinical research site is a rural facility located about 150 km west of Durban, KwaZulu-Natal. The Vulindlela district is home to about half a million residents whose main access to health care is at seven primary healthcare clinics that provide comprehensive services. The CAT Program at Vulindlela is an entirely rural nurse-driven service with 1.5 doctors available for the initial eligibility assessment and for advice and referral.

ACTIVITIES AND EXPECTED RESULTS:

At the eThekwini/Prince Zulu site, patients are referred from the TB clinic, STD clinic, or other CAPRISA research studies. The clinic is open Monday to Friday and is operated by 3 full-time doctors, 2 part-time doctors, 4 nurses, 3 counselors, an assistant and a pharmacist. No inpatient facilities are available at this clinic and all hospitalizations are referred to the local district hospitals, or to King Edward VIII hospital. Patients from throughout the greater Durban area who may have TB are routinely evaluated at Prince Zulu and are routinely offered HIV counseling and testing services through the CAT program. The counseling and testing that is offered includes prevention education and condom distribution. HIV counseling and testing is offered in conjunction with rapid HIV tests and confirmed when necessary by laboratory ELISA tests. HIV negative patients are invited to participate in ongoing prevention activities at both facilities. Patients who test positive for HIV are offered HIV specific care through the CAT Program. The CAT Program offers extensive counseling and education around HIV, wellness maintenance, disclosure, and HIV treatment adherence. Patients are also encouraged to bring partners in for testing. In addition, counselors liaise with social welfare departments and other CBOs to enhance social support for patients. Other general HIV care offered include cotrimoxazole prophylaxis, treatment of minor opportunistic infections (OIs), referral to tertiary level facilities when indicated for investigations or hospital admission, and contraception and pap smears for female participants. Patients with CD4 counts between 200 and 350 are seen at 3 monthly intervals, those with CD4 counts 350 to 500 are seen at 6 monthly intervals and those with CD4 counts over 500 are seen at 9 monthly intervals. All patients in the CAT Program with CD4 counts under 200 see a clinician monthly for clinical and laboratory follow-up. These patients are initiated on ART following a clinical and laboratory safety assessment, as well as 3 or more intensive sessions of adherence support

counseling. TB management is done routinely at the Prince Zulu clinic and in accordance with the South African National TB control program.

TB is a common presenting OI among HIV-infected patients, as well as a common occurrence among stable patients on ART due to the high background TB disease burden in KwaZulu-Natal. The CAT program enhances the existing TB services by making available laboratory-based TB diagnostics to patients, assisting with TB treatment adherence, as well as with regular clinical and laboratory-based monitoring of drug related side-effects. In patients on anti-TB drugs and ART, these side-effects are always managed by clinicians employed by the CAT program. All patients that are not currently on anti-TB therapy are routinely evaluated for the occurrence of incidental TB by a symptom checklist, and where indicated additional sputum or radiological diagnostics may be requested.

Patients at Vulindlela are referred from the Mafakhatini primary healthcare clinic, research programs (including the microbicide trial, adolescent cohort, community-based VCT Project) and community referrals (community health workers, community advocates and 30 youth peer-educators). The CAT program in Vulindlela will address issues of stigma and discrimination and is linked to an Oxfam-funded project which addresses stigma and discrimination in the community. The CAT program provides support for disclosing to family members and assists patients in obtaining disability grants. CAPRISA has an extensive community program which supports and facilitates community involvement and informed participation for all CAPRISA projects. Comprehensive services are provided to HIV-infected participants where appropriate. This includes pre- and post-test counseling for HIV infection, treatment and adherence education and support, implementation of ARV treatment, prophylaxis for opportunistic infections, and management of OIs, adverse and serious adverse events. These are done at the clinic and through appropriate referral channels when needed. Only adolescents 14 years or older are targeted. Currently no HIV-related services are offered by CAPRISA to a pediatric population.

In FY 2007, CAPRISA plans to start transitioning stable patients to the Department of Health rollout site. Discussions are already in underway with the KwaZulu-Natal Health Department to facilitate the smooth transition of patients. It is anticipated that five patients per week will be transitioned which will not overburden the receiving facility.

EXPECTED RESULTS:

ART will be expanded in FY 2007 at both the eThekwini and Vulindlela sites. CAPRISA does not anticipate having to expand the space or staff at these facilities to reach the FY 2007 targets. Laboratory services will continue to be performed at the CAPRISA Laboratory. From October 2006, patients will start to be transitioned to the Department of Health at a rate of approximately 20 per month from each site and new patients will be enrolled to maintain a steady cohort.

These results contribute to the PEPFAR 2-7-10 goals by increasing the number of newly initiated patients on antiretroviral therapy.

INTEGRATED ACTIVITY FLAG:

This activity is part of an ongoing comprehensive PEPFAR-funded treatment program implemented by the Center for the AIDS Program of Research in South Africa (CAPRISA) that includes Basic Health Care and Support (#7499), CT (#7496), ARV Services (#7497) and ARV Drugs (#7498).

SUMMARY:

While knowledge of HIV status is an important gateway for HIV prevention and care, stigma and discrimination (perceived and/or real) is a barrier to uptake of voluntary counseling and testing (VCT) services. High HIV incidence rates in young women are an important driver of the epidemic in sub-Saharan Africa. This FY 2007 activity will build on and expand the ongoing generation of strategic information in the Vulindlela district of KwaZulu-Natal to enhance CAPRISA's AIDS Treatment (CAT) program. It proposes to advance, deepen understanding of, and develop strategies for: 1) enhancing and supporting safe disclosure of HIV status; 2) increasing uptake of HIV testing and preparedness for an HIV test; and 3) reducing HIV acquisition in young women. This strategic information is critical for understanding behaviors in the context of antiretroviral (ARV) treatment provision in this rural, geographically defined community at the epicenter of the HIV pandemic.

BACKGROUND:

The CAPRISA Vulindlela Research Facility was established in 2003 to better understand the evolving HIV epidemic in this community and to contribute to HIV prevention, understanding the pathogenesis, and scaling-up ARV treatment access in partnership with the community and the KwaZulu-Natal Department of Health. The PEPFAR-funded CAT Program was initiated to provide care and ARV treatment to HIV-infected volunteers identified through screening processes for CAPRISA's prevention research.

This program, initiated in April 2005, has contributed to infrastructure development, appointment of peer educators from the community, staff capacity building for treatment provision, community outreach activities to understand stigma and discrimination, promotion of HIV prevention interventions including knowledge of HIV status and establishment of a cohort of young uninfected young women to enhance understanding of HIV acquisition. These foundation activities and strategic information generated in the first year are being expanded to strengthen and deepen understanding of issues relating to stigma and discrimination, uptake of VCT services and drivers of HIV acquisition in young women. This information is critical to design strategies and interventions that target these areas and thereby the current epidemic trajectory in this and similar communities, including ARV treatment provision.

Despite the high prevalence of HIV infection and knowledge of HIV prevention and treatment, the majority of individuals are unaware of their HIV status. The peer educator program and extensive community outreach activities at this site have resulted in an almost five-fold increase in uptake of HIV testing since its inception. While this is a major advance, it is important to better understand why individuals choose to have an HIV test to refine strategies in this regard.

Stigma and discrimination is a major barrier to knowledge of HIV status and uptake of prevention and treatment services. Prior research in this community highlighted how pervasive this was in this community. In the first year of this program, 200 CAT patients were interviewed to determine rates of disclosure of HIV status, reasons for, and responses to HIV status disclosure and whether they had encouraged others to have an HIV test. Based on this data CAPRISA is trying to understand the role of ARV treatment access on HIV status disclosure in CAT patients. This information will be used to develop strategies for supporting HIV status disclosure.

In sub-Saharan Africa young women aged 15 to 24 years are three to six times more likely to be infected than young men in the same age group. In Vulindlela, about two-thirds of antenatal clients are under the age of 24 years and HIV prevalence is about 40% underscoring the need to focus on sexually active young women. The establishment of the

cohort of young, sexually active HIV uninfected women in the first year through the CAPRISA seroincidence study has provided a useful mechanism to understand rates of, and factors influencing HIV acquisition in this group. The role of age of sexual partner, family structure, sexual practices, sexual networking patterns, other sexually transmitted infections (STIs) as drivers of HIV transmission are being better understood. These data are important for designing targeted interventions for HIV prevention and changing behaviors of persons on ARV treatment in CAT.

ACTIVITIES and EXPECTED RESULTS:

ACTIVITY 1: Increasing uptake of VCT services

Peer educators will continue to build on outreach activities to promote knowledge of HIV status, support ARV treatment adherence and minimize AIDS-related stigma and discrimination. They will conduct home visits and, where needed, transport young people to the CAPRISA VCT service for VCT, facilitate positive persons support networks and ARV treatment adherence. Understanding the reasons and preparedness to have an HIV test will enable CAPRISA to generate important information to enhance uptake of VCT services.

ACTIVITY 2: Supporting safe disclosure of HIV status

Previous data collected through a cross-sectional survey in Vulindlela (N=594) to assess the extent and impact of perceived HIV and AIDS stigma and discrimination on the willingness to disclose a hypothetical HIV-positive status showed that participants anticipated high levels of stigma and discrimination from the community, with women more likely to report this. Ninety percent anticipated support from their families should they be HIV-infected, but women were more likely (75%) to expect forced isolation from their families if infected with HIV. Gender sensitive community interventions that confront AIDS stigma and discrimination in a human rights perspective are needed to ensure safe and supportive environments for disclosing an HIV-positive status. In FY 2007, the focus will shift to assessing the impact of access to ARV treatment in disclosure of HIV-positive status to enhance strategies to support safe disclosure of HIV status.

ACTIVITY 3: Drivers of HIV transmission in young women

The HIV incidence rate in the cohort of young women established in the first year is 7.5 per 100 women-years of follow-up [95%CI: 4.3-10.4]. Low rates of condom use, a stable partner being over 20 years of age, low contraceptive use, anal sex and the presence of other STIs were significantly associated with HIV acquisition in this cohort of young women. A combination of PCR technology and a Clinical Evaluation Tool (CET) was used to identify early HIV infection. Through this cohort and CAT, data were generated on HIV transmission in uninfected women, recently infected women and men and women with established HIV infection on and off ARV treatment and enhance intervention design to impact HIV transmission dynamics. FY 2007 activities to enhance understanding of what is driving HIV acquisition in these young women will be invaluable for understanding HIV risk behaviors in the context of ARV treatment provision. Data will be used to develop a partner level intervention to reduce HIV infection in young women.

This activity generates key strategic information to enhance strategies and development of interventions for increasing uptake of VCT, reducing stigma and discrimination, reducing HIV acquisition especially in young women and enhancing ARV treatment provision. These results contribute directly to the PEPFAR 2-7-10 goals by producing valuable information to guide current and future prevention and treatment activities in this, and similar settings.