About

The Swaziland HIV Incidence Measurement Survey (SHIMS) was initiated in 2010 to assess the population-level impact of Soka Uncobe in the context of other HIV prevention initiatives. SHIMS is a multi-phased study that measures HIV prevalence and incidence before and after the scale-up of these interventions.

The accurate measurement of HIV incidence (i.e., the rate of new infections that develop during a specified period of time) is critical to informing national prevention strategies and for identifying high risk populations in greatest need of HIV prevention services. Incidence estimates can also be used to measure the effectiveness of prevention programs to reduce the number of new infections in the given population.

Prior incidence estimates in Swaziland were derived from mathematical models which are based on previous rounds of HIV prevalence measurements. Incidence estimates derived from these models do not provide real-time information on the HIV epidemic needed to make program decisions and include many assumptions of survival and mortality that may not be applicable to Swaziland.

A key feature of SHIMS is the direct observation of HIV seroconversions within a nationally representative cohort of men and women, 18-49 years old. Through use of direct observation of seroconversions, a more accurate HIV incidence measure can be estimated. Additionally, SHIMS provides an updated HIV prevalence which can be compared to the prior estimate derived in 2007 [CSO 2008].

Primary objectives

  1. To estimate HIV incidence rates in a household-based, nationally representative sample of men and women ages 18-49, before and after the scale up of Soka Uncobe in the context of other the HIV combination prevention programs.
  2. To estimate the HIV incidence rates among circumcised and uncircumcised men, after Soka Uncobe, in a household-based nationally representative sample,

Secondary objectives

  1. To examine the association of baseline demographic characteristics and HIV incidence and prevalence in a household-based representative sample of men and women before and after completion of Soka Uncobe.
  2. To determine the prevalence of circumcision among a household-based representative sample of men before and after completion of Soka Uncobe.
  3. To estimate HIV prevalence rates among men and women in a household-based representative sample of men and women before and after completion of Soka Uncobe.

Principal Investigators


Rejoice Nkambule, deputy director, Health Services Directorate, Swaziland Ministry of Health; George Bicego, country manager, Office of the Director, Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC); Jessica Justman, senior technical director, ICAP at Columbia University; Jason Reed, medical epidemiologist, Center for Global Health, Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC).

Additional support

Swaziland’s National Reference Laboratory and Central Statistical Office. Statistical Center for HIV/AIDS Research & Prevention (SCHARP) at the Fred Hutchinson Cancer Center in the United States. Maromi Health Research and EpiCentre, South Africa.

References:
Central Statistical Office (CSO) [Swaziland], and Macro International Inc. Swaziland Demographic and Health Survey 2006-07. Mbabane, Swaziland: Central Statistical Office and Macro International Inc; 2008.