HIV among older adults in Zimbabwe: Ageing with HIV or seroconverting after age 50?

J. Negin1, C. Nyamukapa2,3, J. Eaton3, N. Schur3, A. Takaruza2, P. Mason2,4, S. Gregson2,3

Counting the Hard to CountAIDS 2014, 23 July 2014

1University of Sydney School of Public Health, Australia, 2Biomedical Research and Training Institute, Harare, Zimbabwe, 3Imperial College School of Public Health, London, United Kingdom, 4University of Zimbabwe, Harare, Zimbabwe

Background – ageing of the cohort

• With ART scale-up, more people are living longer with HIV

• 3 million PLHIV aged ≥50 years in Africa

• Increasing proportion of PLHIV are aged 50+

Proportion of PLHIV aged over 50yrs, Manicaland, Zimbabwe, 2001-2011

RESEARCH QUESTION:What percentage of older adults living with HIV have “aged with

HIV” and what percentage seroconverted at age 50 or older?

2001-02 2003-05 2006-08 2009-110%

5%

10%

15%

7.5%8.4%

8.5%11.5%

4.8%

8.1%

13.8%malefemale

• Data from a population-based cohort in eastern Zimbabwe• Five survey rounds completed: 1998 to 2011• Participants completed a 1-2 hour interview; dried blood

spots taken & tested for HIV• Eligibility criteria included males aged 17–54 & females aged

15–44 (expanding to 15-54 for both sexes in 2003)

Methods in brief

• Total of 58099.9 person years among 11,883 individuals - average of 4.89 years per person

• Incidence rate of 1.22 per 100 person years overall• Incidence rate of 0.69 per 100 person-years in 50+

• Of 80 people in the dataset aged 50+ at last survey and living with HIV (for whom date of sero-conversion was available), 45 (56.3%) sero-converted at ages ≥50 - rather than aged into their 50s already with HIV

• 31.2% of the older individuals sero-converted in the last 3 years

Sero-conversion is occurring among older adults

Age Group Sex Sero-conversions Person Years Incidence Rate per 100 PY

All All 710 58,100 1.22 Male 274 22,465 1.22 Female 436 35,635 1.2250+ All 45 6,499 0.69 Male 22 2,228 0.99 Female 23 4,271 0.54

• Older adults can no longer be neglected by prevention & treatment services

• Targeted services are needed• As people survive longer on treatment & HIV incidence is

reduced, HIV among older adults will become central to the HIV response

• Issues of multi-morbidity will become more prominent in treatment programs

Conclusions

Acknowledgements

We would like to express our sincerest gratitude to the data collection & data entry team in Zimbabwe

for doing a wonderful job!

We thank Wellcome Trust for funding the Manicaland Project.

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Contactjoel.negin@sydney.edu.au