{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T15:16:17Z","timestamp":1774278977070,"version":"3.50.1"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["AI027757"],"award-info":[{"award-number":["AI027757"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["AI138620"],"award-info":[{"award-number":["AI138620"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Household-based tuberculosis (TB) contact evaluation may be an efficient strategy to reach people who could benefit from oral pre-exposure prophylaxis (PrEP) because of the epidemiological links between HIV and TB. This study estimated the number of HIV serodifferent couples in TB-affected households and potential HIV acquisitions averted through their PrEP use in 4 TB-HIV high-burden countries. We conducted a model-based analysis set in Ethiopia, Kenya, South Africa, and Uganda using parameters from population-based household surveys, systematic literature review and meta-analyses, and estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We parameterized the nonlinear relationship between the proportion of serodifferent couples among people living with HIV and population-level HIV prevalence using Markov chain Monte Carlo methods. We integrated all parameters in a mathematical model and propagated uncertainty using a Monte Carlo approach. We estimated the HIV prevalence among adults aged 15\u201349 living in TB-affected households to be higher than in the general population in all 4 countries. The proportion of serodifferent couples among all couples in TB-affected households was also higher than in the general population (South Africa: 20.7% vs. 15.7%, Kenya: 15.7% vs. 5.7%, Uganda: 14.5% vs. 6.0%, Ethiopia: 4.1% vs. 0.8%). We estimated that up to 1,799 (95% UI: 1,256\u20132,341) HIV acquisitions in South Africa could be prevented annually by PrEP use in serodifferent couples in TB-affected households, 918 (95% UI: 409\u20131,450) in Kenya, 686 (95% UI: 505\u2013871) in Uganda, and 408 (95% UI: 298\u2013522) in Ethiopia. As couples in TB-affected households are more likely to be serodifferent than couples in the general population, offering PrEP during household TB contact evaluation may prevent a substantial number of HIV acquisitions.<\/jats:p>","DOI":"10.1371\/journal.pgph.0002609","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T17:41:21Z","timestamp":1714671681000},"page":"e0002609","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modeled estimates of HIV-serodifferent couples in tuberculosis-affected households in four sub-Saharan African countries"],"prefix":"10.1371","volume":"4","author":[{"given":"Meixin","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley S.","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Godwin","family":"Anguzu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruanne V.","family":"Barnabas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8629-9992","authenticated-orcid":true,"given":"J. Lucian","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Mujugira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham D.","family":"Flaxman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5677-939X","authenticated-orcid":true,"given":"Jennifer M.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"key":"pgph.0002609.ref001","unstructured":"World Health Organization. Global tuberculosis report 2022. 2022."},{"key":"pgph.0002609.ref002","unstructured":"World Health Organization. WHO policy on collaborative TB\/HIV activities\u2014guidelines for national programmes and other stakeholders. Geneva; 2012. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241503006"},{"key":"pgph.0002609.ref003","unstructured":"World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva, Switzerland; 2018."},{"key":"pgph.0002609.ref004","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/1471-2334-14-91","article-title":"Efficacy of isoniazid prophylactic therapy in prevention of tuberculosis in children: a meta-analysis","volume":"14","author":"J Ayieko","year":"2014","journal-title":"BMC Infect Dis"},{"key":"pgph.0002609.ref005","author":"Stop TB Partnership","year":"2018","journal-title":"UN high-level meeting on TB: key targets & commitments for 2022"},{"key":"pgph.0002609.ref006","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1093\/aje\/kwx380","article-title":"Resistance and Susceptibility to Mycobacterium tuberculosis Infection and Disease in Tuberculosis Households in Kampala, Uganda","volume":"187","author":"CM Stein","year":"2018","journal-title":"Am J Epidemiol"},{"key":"pgph.0002609.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0155688","article-title":"Household HIV testing uptake among contacts of TB patients in South Africa.","volume":"11","author":"K Velen","year":"2016","journal-title":"PLoS One."},{"key":"pgph.0002609.ref008","unstructured":"World Health Organization. Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries. Geneva, Switzerland; 2012. Available: https:\/\/www.who.int\/tb\/publications\/2012\/contact_investigation2012\/en\/"},{"key":"pgph.0002609.ref009","doi-asserted-by":"crossref","first-page":"72","DOI":"10.5588\/pha.18.0014","article-title":"Integrating home HIV counselling and testing into household TB contact investigation: a mixed-methods study.","volume":"8","author":"E Ochom","year":"2018","journal-title":"Public Heal Action."},{"key":"pgph.0002609.ref010","article-title":"Vikela Ekhaya: a novel, community-based, tuberculosis contact management program in a high burden setting","author":"AW Kay","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pgph.0002609.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0095372","article-title":"Incidence of TB and HIV in prospectively followed household contacts of TB index patients in South Africa.","volume":"9","author":"C Van Schalkwyk","year":"2014","journal-title":"PLoS One."},{"key":"pgph.0002609.ref012","year":"2020","journal-title":"National Institutes of HealthNIAID HIV Language."},{"key":"pgph.0002609.ref013","author":"World Health Organization","year":"2021","journal-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery, and monitoring."},{"key":"pgph.0002609.ref014","unstructured":"Federal Democratic Republic of Ethiopia Ministry of Health. Implementation Manual for Pre-Exposure Prophylaxis (PrEP) of HIV Infection. Addis Ababa; 2019."},{"key":"pgph.0002609.ref015","unstructured":"Kenya Ministry of Health National AIDS & STI Control Program. Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya. Nairobi; 2018."},{"key":"pgph.0002609.ref016","unstructured":"South African National Department of Health. Guidelines for the Provision of Pre-exposure Prophylaxis (PrEP) to Persons at Substantial Risk of HIV Infection. 2020. Available: https:\/\/www.prepwatch.org\/resource\/south-african-guidelines-prep-2020\/"},{"key":"pgph.0002609.ref017","year":"2018","journal-title":"Uganda Ministry of HealthConsolidated Guidelines for Prevention and Treatment of HIV in Uganda."},{"key":"pgph.0002609.ref018","doi-asserted-by":"crossref","first-page":"e25588","DOI":"10.1002\/jia2.25588","article-title":"Uptake and retention on HIV pre\u2010exposure prophylaxis among key and priority populations in South\u2010Central Uganda.","volume":"23","author":"J Kagaayi","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"pgph.0002609.ref019","doi-asserted-by":"crossref","first-page":"e1002885","DOI":"10.1371\/journal.pmed.1002885","article-title":"Integrating preexposure prophylaxis delivery in routine family planning clinics: A feasibility programmatic evaluation in Kenya.","volume":"16","author":"KK Mugwanya","year":"2019","journal-title":"PLOS Med"},{"key":"pgph.0002609.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2020\/1675987","article-title":"Preconception Care Uptake and Immediate Outcomes among Discordant Couples Accessing Routine HIV Care in Kenya.","volume":"2020","author":"N Gitahi","year":"2020","journal-title":"Obstet Gynecol Int."},{"key":"pgph.0002609.ref021","doi-asserted-by":"crossref","first-page":"e438","DOI":"10.1016\/S2352-3018(19)30144-4","article-title":"HIV incidence, pregnancy, and implementation outcomes from the Sakh\u2019umndeni safer conception project in South Africa: a prospective cohort study","volume":"6","author":"SR Schwartz","year":"2019","journal-title":"Lancet HIV"},{"key":"pgph.0002609.ref022","doi-asserted-by":"crossref","first-page":"e25261","DOI":"10.1002\/jia2.25261","article-title":"Implementation of a comprehensive safer conception intervention for HIV\u2010serodiscordant couples in Kenya: uptake, use and effectiveness","volume":"22","author":"R Heffron","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"pgph.0002609.ref023","doi-asserted-by":"crossref","first-page":"e0241399","DOI":"10.1371\/journal.pone.0241399","article-title":"Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda.","volume":"15","author":"TR Muwonge","year":"2020","journal-title":"PLoS One"},{"key":"pgph.0002609.ref024","doi-asserted-by":"crossref","first-page":"e25113","DOI":"10.1002\/jia2.25113","article-title":"Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1 serodiscordant couples in East Africa: a qualitative evaluation study","volume":"21","author":"NC Ware","year":"2018","journal-title":"Uganda. J Int AIDS Soc"},{"key":"pgph.0002609.ref025","unstructured":"Ethiopia Central Statistical Agency. Ethiopia Demographic and Health Survey 2016\u2014HIV Prevalence Report. 2018. Available: https:\/\/dhsprogram.com\/publications\/publication-fr328-dhs-final-reports.cfm"},{"key":"pgph.0002609.ref026","unstructured":"Kenya Ministry of Health National AIDS and STI Control Programme. Kenya Population-based HIV Impact Assessment (KENPHIA) 2018. Nairobi; 2020. Available: https:\/\/www.health.go.ke\/wp-content\/uploads\/2020\/02\/KENPHIA-2018-PREL-REP-2020-HR3-final.pdf"},{"key":"pgph.0002609.ref027","unstructured":"Uganda Ministry of Health. Uganda Population-Based HIV Impact Assessment (UPHIA) 2016\u20132017. Kampala; 2019. Available: https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2020\/02\/UPHIA_Final_Report_Revise_07.11.2019_Final_for-web.pdf"},{"key":"pgph.0002609.ref028","author":"South Africa National Department of Health.","year":"2019","journal-title":"South Africa Demographic and Health Survey 2016"},{"key":"pgph.0002609.ref029","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1111\/tmi.13485","article-title":"National tuberculosis prevalence surveys in Africa, 2008\u20132016: an overview of results and lessons learned","volume":"25","author":"I Law","year":"2020","journal-title":"Trop Med Int Heal"},{"key":"pgph.0002609.ref030","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1016\/S0140-6736(16)30388-9","article-title":"Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement","volume":"388","author":"GA Stevens","year":"2016","journal-title":"Lancet"},{"key":"pgph.0002609.ref031","article-title":"Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990\u20132019: results from the Global Burden of Disease Study 2019.","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"pgph.0002609.ref032","doi-asserted-by":"crossref","first-page":"101206","DOI":"10.1016\/j.eclinm.2021.101206","article-title":"Estimating the population at high risk for tuberculosis through household exposure in high-incidence countries: a model-based analysis","volume":"42","author":"JM Ross","year":"2021","journal-title":"EClinicalMedicine"},{"key":"pgph.0002609.ref033","doi-asserted-by":"crossref","first-page":"e0209098","DOI":"10.1371\/journal.pone.0209098","article-title":"Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya.","volume":"13","author":"M Enos","year":"2018","journal-title":"PLoS One."},{"key":"pgph.0002609.ref034","unstructured":"Ministry of Health. Uganda National TB Prevalence Survey Report. Kampala, Uganda; 2017."},{"key":"pgph.0002609.ref035","article-title":"Prevalence of bacteriologically confirmed pulmonary tuberculosis in South Africa, 2017\u201319: a multistage, cluster-based, cross-sectional survey.","author":"S Moyo","year":"2022","journal-title":"Lancet Infect Dis."},{"key":"pgph.0002609.ref036","unstructured":"World Health Organization. Global tuberculosis report 2021. Geneva; 2021. Available: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports"},{"key":"pgph.0002609.ref037","year":"2016","journal-title":"Uganda Bureau of StatisticsUganda Demographic and Health Survey"},{"key":"pgph.0002609.ref038","author":"Kenya Bureau of Statistics","journal-title":"Kenya Demographic and Health Survey"},{"key":"pgph.0002609.ref039","doi-asserted-by":"crossref","first-page":"3","DOI":"10.12688\/gatesopenres.12752.2","article-title":"Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa.","volume":"1","author":"R Heffron","year":"2018","journal-title":"Gates Open Res"},{"key":"pgph.0002609.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0192089","article-title":"Household point of care CD4 testing and isoniazid preventive therapy initiation in a household TB contact tracing programme in two districts of South Africa.","volume":"13","author":"L Page-Shipp","year":"2018","journal-title":"PLoS One"},{"key":"pgph.0002609.ref041","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2020.37.87.21102","article-title":"Latent tuberculosis among household contacts of pulmonary tuberculosis cases in Nairobi, Kenya.","volume":"37","author":"S Odera","year":"2020","journal-title":"Pan Afr Med J."},{"key":"pgph.0002609.ref042","first-page":"185","article-title":"Community-based targeted case finding for tuberculosis and HIV in household contacts of patients with tuberculosis in South Africa","author":"AE Shapiro","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"pgph.0002609.ref043","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0230376","article-title":"Prevalence and risk factors for latent tuberculosis infection among household contacts of index cases in two South African provinces: Analysis of baseline data from a cluster-randomised trial.","volume":"15","author":"P MacPherson","year":"2020","journal-title":"PLoS One"},{"key":"pgph.0002609.ref044","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.5588\/ijtld.18.0108","article-title":"HIV testing uptake among the household contacts of multidrug-resistant tuberculosis index cases in eight countries","volume":"22","author":"VS Opollo","year":"2018","journal-title":"Int J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis"},{"key":"pgph.0002609.ref045","first-page":"25","article-title":"Tuberculosis disease and infection among household contacts of bacteriologically confirmed and non-confirmed tuberculosis patients","author":"K Warria","year":"2020","journal-title":"Trop Med Int Heal"},{"key":"pgph.0002609.ref046","first-page":"16","article-title":"An evaluation of \u201cRibolola\u201d: A household tuberculosis contact tracing programme in North West Province, South Africa.","author":"D Thind","year":"2012","journal-title":"Int J Tuberc Lung Dis."},{"key":"pgph.0002609.ref047","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1186\/s12879-023-08365-y","article-title":"Frequency of HIV serodifferent couples within TB-affected households in a setting with a high burden of HIV-associated TB.","volume":"23","author":"G Anguzu","year":"2023","journal-title":"BMC Infect Dis."},{"key":"pgph.0002609.ref048","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/QAI.0000000000002509","article-title":"Brief Report: Proportion and Predictors of Adult TB Contacts Accepting HIV Testing During an Active TB Case Finding Intervention in South Africa.","volume":"85","author":"NW Albaugh","year":"2020","journal-title":"J Acquir Immune Defic Syndr."},{"key":"pgph.0002609.ref049","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/QAI.0000000000001617","article-title":"Brief Report: \u201cGive Me Some Time\u201d: Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda.","volume":"77","author":"M Armstrong-Hough","year":"2018","journal-title":"J Acquir Immune Defic Syndr."},{"key":"pgph.0002609.ref050","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1007\/s10461-022-03796-1","article-title":"Acceptability Assessment in HIV Prevention and Treatment Intervention and Service Delivery Research: A Systematic Review and Qualitative Analysis","volume":"27","author":"KF Ortblad","year":"2023","journal-title":"AIDS Behav"},{"key":"pgph.0002609.ref051","doi-asserted-by":"crossref","first-page":"e0196613","DOI":"10.1371\/journal.pone.0196613","article-title":"Temporal evolution of HIV sero-discordancy patterns among stable couples in sub-Saharan Africa","volume":"13","author":"SF Awad","year":"2018","journal-title":"PLoS One"},{"key":"pgph.0002609.ref052","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1136\/sextrans-2011-050114","article-title":"Distinct HIV discordancy patterns by epidemic size in stable sexual partnerships in sub-Saharan Africa.","volume":"88","author":"H Chemaitelly","year":"2012","journal-title":"Sex Transm Infect"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0002609","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T17:42:24Z","timestamp":1714671744000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0002609"}},"subtitle":[],"editor":[{"given":"Riti","family":"Sharan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,2]]},"references-count":52,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0002609","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,2]]}}}