BMJ Open 2:e000626 doi:10.1136/bmjopen-2011-000626
  • Epidemiology
    • Research

HIV incidence and prevalence among cohorts of women with higher risk behaviour in Bloemfontein and Rustenburg, South Africa: a prospective study

  1. Shelly Fischer1
  1. 1FHI 360, Research Triangle Park, USA
  2. 2The Aurum Institute, Johannesburg, South Africa
  3. 3JOSHA Research, Bloemfontein, Free State, South Africa
  1. Correspondence to Dr Paul Feldblum; pfeldblum{at}
  • Received 1 December 2011
  • Accepted 16 January 2012
  • Published 13 February 2012


Objectives The primary objective was to measure HIV incidence in two prospective cohorts of HIV-negative women. Secondary objectives included measuring pregnancy rates and participant retention rates.

Design Cross-sectional HIV screening of women selected for higher risk behaviours, with a subsequent prospective study of uninfected women, followed monthly for up to 6 months.

Setting Clinics established for research purposes in Bloemfontein and Rustenburg, South Africa.

Participants The authors enrolled women 18–35 years old and presumed at higher risk of sexual acquisition of HIV as indicated by self-reported sexual behaviour or recent sexually transmitted infection symptoms. In Bloemfontein, 1364 women were screened, 1154 were eligible for HIV testing and 1145 agreed to be tested. The prospective study enrolled 401 HIV-negative women. In Rustenburg, 946 women were screened, 540 were eligible and underwent HIV testing and 223 HIV-negative women entered the prospective study.

Primary and secondary outcomes Baseline prevalences of HIV infection and HIV incidence rates in the prospective cohorts, according to a double rapid test algorithm with a third rapid test for discrepant or indeterminate results. Pregnancy prevalences and pregnancy incidence rate in Bloemfontein. Participant retention rates in the prospective cohort until the study end.

Results In Bloemfontein, 1145 women were tested, 391 entered follow-up and 92.3% of participants completed six study visits. In Rustenburg, 540 women were tested, 194 entered follow-up and retention up to the point of early study termination was 88.6%. Overall HIV prevalence was 21.2% (95% CI 18.9% to 23.6%) in Bloemfontein and 23.5% (95% CI 19.9% to 27.1%) in Rustenburg. Overall HIV incidence was 5.5/100 person-years (95% CI 2.5 to 10.4) in Bloemfontein and 3.0/100 person-years (95% CI 0.4 to 10.8) in Rustenburg. Cross-sectional pregnancy prevalences were 6.5% in Bloemfontein and 8.6% in Rustenburg.

Conclusions The authors observed substantial HIV incidence rates in both cohorts. Vigorous prevention efforts are needed in these smaller cities.


  • * Now at the US Centers for Disease Control and Prevention.

  • To cite: Feldblum P, Latka M, Lombaard J, et al. HIV incidence and prevalence among cohorts of women with higher risk behaviour in Bloemfontein and Rustenburg, South Africa: a prospective study. BMJ Open 2012;2:e000626. doi:10.1136/bmjopen-2011-000626

  • Contributors PJF, MHL, JL, CC, P-LC and CS contributed to the design of the study and its essential documents. MHL, JL and CC led data collection. PJF, MHL, JL, P-LC, CS and SF contributed to the analysis and interpretation of the data. PJF, MHL, JL, CC and SF drafted the article. All authors approved the final version of the manuscript.

  • Funding This work was funded by the US Agency for International Development (USAID) under Cooperative Agreement No. GPO-A-00-05-00022-00 and the Contraceptive and Reproductive Health Technologies Research and Utilisation (CRTU) Program. Additional funding was provided by the Centers for Disease Control and Prevention (CDC) under contract no. 200-20074-05314, Task Order #7. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the CDC.

  • Competing interests None.

  • Ethics approval FHI 360 Protection of Human Subjects Committee; University of the Free State Ethics Committee; University of KwaZulu-Natal BREC.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data will be available.

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