CHP coverage was assessed using person-visit data at each survey with descriptive
statistics and logistic regression. Specifically, ART coverage was defined as
the proportion of all HIV positive participants who self-reported ART use,
regardless of ART eligibility criteria, and was assessed overall and separately
by gender. Self-reported ART use in the cohort has been validated previously by
plasma detection of antiretroviral drugs showing a specificity and sensitivity
of 99% (95%CI: 97-100%) and 77% (95%CI: 70-83%), respectively, with no
differences by gender.19 MC coverage at a
given visit was defined as the proportion of men who self-reported being
circumcised. Self-reported circumcision status has been previously validated
from clinical records with 100% specificity.20 Viral suppression was defined using a cutoff of 1000 copies/ml as
per WHO recommendations.21
The unit of exposure for HIV incidence were person-intervals of follow-up between
surveys in initially HIV-negative individuals who participated in at least two
surveys. HIV incident cases were persons who tested HIV-seropositive for the
first time with an HIV seronegative test result at the prior RCCS visit,
allowing for up to one missed visit. Incident infections were assumed to occur
at the mid-point of the interval and changes in HIV incidence per 100 person
years (py) were estimated using Poisson multivariate regression with generalized
estimating equations and an exchangeable correlation structure and were reported
as incidence rate ratios (IRR) with 95% confidence intervals (CI).
To assess the impact of CHP, mean incidence at each visit interval after 2004
(6th survey) was compared to mean HIV incidence over the entire
period prior to ART and MC availability. The final multivariate model included
individual-level information on demographics (gender, age, marital status,
education) and sexual behaviors (sexual partners in the last year, sex with
partners outside the community of residence, sex with non-marital partners,
condom use and self-reported genital ulceration). A categorical term for
community-level HIV prevalence was included to adjust for variation in exposure.
Secondary analyses were stratified by gender and conducted separately for
circumcised and uncircumcised men. HIV incidence and individual risk was also
assessed in relation to community-level measures of ART and MC coverage and
prevalence of HIV viremia (Supplemental statistical methods ).
Sensitivity of results to both selective participation and loss to follow-up were
evaluated using inverse probability weights (Supplemental statistical
methods ). To assess the potential impact of birth cohort effects on
HIV incidence trends, a term for each five-year birth cohort was included in the
multivariate model. HIV incidence was also assessed by gender for each five year
age group.
statistics and logistic regression. Specifically, ART coverage was defined as
the proportion of all HIV positive participants who self-reported ART use,
regardless of ART eligibility criteria, and was assessed overall and separately
by gender. Self-reported ART use in the cohort has been validated previously by
plasma detection of antiretroviral drugs showing a specificity and sensitivity
of 99% (95%CI: 97-100%) and 77% (95%CI: 70-83%), respectively, with no
differences by gender.19 MC coverage at a
given visit was defined as the proportion of men who self-reported being
circumcised. Self-reported circumcision status has been previously validated
from clinical records with 100% specificity.20 Viral suppression was defined using a cutoff of 1000 copies/ml as
per WHO recommendations.21
The unit of exposure for HIV incidence were person-intervals of follow-up between
surveys in initially HIV-negative individuals who participated in at least two
surveys. HIV incident cases were persons who tested HIV-seropositive for the
first time with an HIV seronegative test result at the prior RCCS visit,
allowing for up to one missed visit. Incident infections were assumed to occur
at the mid-point of the interval and changes in HIV incidence per 100 person
years (py) were estimated using Poisson multivariate regression with generalized
estimating equations and an exchangeable correlation structure and were reported
as incidence rate ratios (IRR) with 95% confidence intervals (CI).
To assess the impact of CHP, mean incidence at each visit interval after 2004
(6th survey) was compared to mean HIV incidence over the entire
period prior to ART and MC availability. The final multivariate model included
individual-level information on demographics (gender, age, marital status,
education) and sexual behaviors (sexual partners in the last year, sex with
partners outside the community of residence, sex with non-marital partners,
condom use and self-reported genital ulceration). A categorical term for
community-level HIV prevalence was included to adjust for variation in exposure.
Secondary analyses were stratified by gender and conducted separately for
circumcised and uncircumcised men. HIV incidence and individual risk was also
assessed in relation to community-level measures of ART and MC coverage and
prevalence of HIV viremia (
Sensitivity of results to both selective participation and loss to follow-up were
evaluated using inverse probability weights (
methods
HIV incidence trends, a term for each five-year birth cohort was included in the
multivariate model. HIV incidence was also assessed by gender for each five year
age group.
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