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Medical News

Uganda: Quantifying HIV-1 Transmission Due to Contaminated Injections

March 20, 2008

In order for control efforts to be prioritized, "assessments of the importance of different routes of HIV-1 (HIV) transmission are vital," the authors noted. However, the lack of consistent data and the great uncertainty regarding the risk of HIV transmission from HIV-contaminated injections have made quantifying the proportion of HIV transmission caused by these injections in sub-Saharan Africa "difficult and unavoidably subjective." Estimates of such transmission have ranged from 2.5 percent to 30 percent or greater, depending on the risk assumed.

In the current study, the researchers present a method based on an age-structured transmission model "that allows the relative contribution of HIV-contaminated injections, and other routes of HIV transmission, to be robustly estimated, both fully quantifying and substantially reducing the associated uncertainty."

Adopting a Bayesian perspective, the authors showed how prior beliefs about injection safety and the proportion of HIV infections due to contaminated injections should, in many cases, be substantially modified in light of age-stratified incidence and injection data, producing improved (posterior) estimates.

When this method was applied to data from rural southwest Uganda, the results showed that the higher estimates of the proportion of incidence due to injections were reduced from 15.5 percent (95 percent credible interval, 0.7 percent, 44.9 percent) to 5.2 percent (0.5 percent, 17.0 percent) if random mixing is assumed, and from 14.6 percent (0.7 percent, 42.5 percent) to 11.8 percent (1.2 percent, 32.5 percent) assortative mixing. Lower, more widely accepted estimates remained largely unchanged, from 1 percent to 3 percent (0.1-6.3 percent).

The authors noted in conclusion: "Although important uncertainty remains, our analysis shows that in rural Uganda, contaminated injections are unlikely to account for a large proportion of HIV incidence. This result is likely to be generalizable to many other populations in sub-Saharan Africa."

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Adapted from:
Proc National Acad of Sciences
06.05.2007; Vol. 104; No. 23: P. 9794-9799; Richard G. White, S. Cooper Ben, Anusha Kedhar, Kate K. Orroth, Sam Biraro, Rebecca F. Baggaley, Jimmy Whitworth, Eline L. Korenromp, Azra Ghani, Marie-Claude Boily, Richard J. Hayes

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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