2 research outputs found
Home-based intervention to test and start (HITS) protocol : a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment
Abstract: To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - microincentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women..
Household transmission of SARS-CoV-2 in a rural area in South Africa
Background.
Patterns of SARSâCoVâ2 spread have varied by geolocation, with differences in seroprevalence between urban and rural areas, and between waves. Household spread of SARSâCoVâ2 is a known source of new COVIDâ19 infections, with rural areas in subâSaharan Africa being more prone than urban areas to COVIDâ19 transmission because of limited access to water in some areas, delayed healthâ seeking behaviour and poor access to care.
Objectives.
To explore SARSâCoVâ2 infection incidence and transmission in rural households in South Africa (SA). Methods. We conducted a prospective household cluster investigation between 13 April and 21 July 2021 in the Matjhabeng subdistrict, a rural area in Free State Province, SA. Adults with SARSâCoVâ2 confirmed by polymerase chain reaction (PCR) tests (index cases, ICs) and their household contacts (HCs) were enrolled. Household visits conducted at enrolment and on days 7, 14 and 28 included interviewerâ administered questionnaires and respiratory and blood sample collection for SARSâCoVâ2 PCR and SARSâCoVâ2 immunoglobulin G serological testing, respectively. Coâprimary cases were HCs with a positive SARSâCoVâ2 PCR test at enrolment. The incidence rate (IR), using the Poisson distribution, was HCs with a new positive PCR and/or serological test per 1 000 personâdays. Associations between outcomes and HC characteristics were adjusted for intraâcluster correlation using robust standard errors. The secondary infection rate (SIR) was the proportion of new COVIDâ19 infections among susceptible HCs.
Results.
Among 23 ICs and 83 HCs enrolled, 10 SARSâCoVâ2 incident cases were identified, giving an IR of 5.8 per 1 000 personâdays (95% confidence interval (CI) 3.14 â 11.95). Households with a coâprimary case had higher IRs than households without a coâprimary case (crude IR 14.16 v. 1.75, respectively; p=0.054). HIV infection, obesity and the presence of chronic conditions did not materially alter the crude IR. The SIR was 15.9% (95% CI 7.90 â 29.32). Households with a lower household density (fewer household members per bedroom) had a higher IR (IR 9.58; 95% CI 4.67 â 21.71) than households with a higher density (IR 3.06; 95% CI 1.00 â 12.35).
Conclusion.
We found a high SARSâCoVâ2 infection rate among HCs in a rural setting, with 48% of households having a coâprimary case at the time of enrolment. Households with coâprimary cases were associated with a higher seroprevalence and incidence of SARSâCoVâ2. Sociodemographic and health characteristics were not associated with SARSâCoVâ2 transmission in this study, and we did not identify any transmission risks inherent to a rural setting