Swaziland HIV Incidence Measurement Survey 2

Columbia University15,429 enrolled

Overview

The second Swaziland HIV Incidence Measurement Survey (SHIMS 2, 2016), is a population based HIV Impact Assessment (PHIA) that will assess the prevalence of key human immunodeficiency virus (HIV)-related health indicators. This is a two-stage cluster sampled cross-sectional survey of 6,417 randomly selected households in Swaziland. Approximately 20,292 eligible persons will be approached (4,664 participants 0-14 years; 12,563 participants 15-49 years; 3,065 participants 50 years and older). Of the sample approached, 15,403 are expected to agree to a blood draw for home-based HIV rapid testing including 3,361 participants 0-14 years; 9,680 participants 15-49 years; and 2,362 participants 50 years and older. SHIMS 2, 2016 will characterize HIV incidence, prevalence, viral load suppression, cluster of differentiation 4 (CD4) T-cell distribution, and risk behaviors in a household-based, nationally-representative sample of the Swazi population and will describe uptake of key HIV prevention, care, and treatment services.

After nearly three decades of Swaziland's national HIV response, a rigorous, population-based measure of the above biological endpoints will provide a valuable follow-up assessment of the impact of the national HIV program. National HIV prevalence and incidence surveys have been carried out in several countries including Uganda (2004), Tanzania (2003), Kenya (2007, 2012), and Swaziland (2011). Specifically in Swaziland, the 2011 SHIMS survey provided critical data on national-level, population-based HIV prevalence, HIV incidence, self-reported antiretroviral therapy (ART) use and viral suppression (VS) among adults 18-49 years. Importantly, SHIMS 2011 lacked data on HIV incidence among participants aged 15-17 years and adults older than 49 years, and HIV prevalence among children 0-14 years. Lack of this vital information limits effective national program planning, resource mobilization, and allocation. SHIMS 2, 2016 will measure HIV incidence and other HIV-related measures, such as CD4 T-cell count distribution, viral load setpoint (VLS), and prevalence of ARV metabolites and transmitted HIV in Swaziland. SHIMS 2, 2016 will provide an opportunity to characterize the current status of the HIV epidemic and provide greater clarity on the impact of the national HIV program. It will provide important updated information on HIV incidence and uptake of HIV-related services that will allow for measurement of program impact and progress towards 90-90-90 targets. The survey will also estimate the prevalence and distribution of selected behaviors typically associated with HIV acquisition and transmission, for targeted programing in the continued scale-up of HIV services. SHIMS 2, 2016 will assess the impact of the HIV control efforts in Swaziland, and inform programs moving forward to better tailor the approaches to the most impactful intervention areas and groups that need them. The data will be used to assess country specific HIV indicators, including the impact of the expansion of HIV prevention and treatment programs to facilitate effective monitoring of national HIV programs.

Outcomes

Primary Outcomes

HIV incident rate among adults 15 years and older

The survey will allow calculation of a national HIV incidence estimate using HIV-1 Limiting Antigen (LAg)-Avidity Enzyme Immunoassay

Time frame: 1 year

Sub-national prevalence of suppressed HIV viral load (<1,000 copies/mL) among adults 15 and older

Viral load (VL) (viral copies/mL) of HIV-infected participants will be measured using Abbott, Roche, or similar platform

Time frame: 1 year

HIV prevalence of children ages 0-14

A representation of the child population will be sampled

Time frame: 1 year

Secondary Outcomes

HIV Prevalence in 2016 among adults 15 years and older

The entire adult population will be sampled

Time frame: 1 year

HIV incidence estimates among young women aged 18-24 in 2011 versus 2016

The incidence estimates measured in 2016 will be compared to the previous survey incidence estimates in 2011

Time frame: 1 year

Incidents of HIV infection among adults from risky behaviors

Questionnaire indicators will be used for this measure, specifically questions on sexual behavior and other risky behaviors

Time frame: 1 year

Mean population viral load among adults living with HIV

Viral load of HIV-infected participants will be measured using Abbott, Roche, or a similar platform

Time frame: 1 year

Prevalence of adult viral suppression in 2011 versus 2016

The viral load suppression measured in 2016 will be compared to the previous survey in 2011, national and regional

Time frame: 1 year

CD4+ count distribution of adults living with HIV

The total population of HIV positive adults will be sampled, national

Time frame: 1 year

Enrollment rate in HIV care among adults with prevalent HIV infection