HIV-seroconversion among HIV-1 serodiscordant married couples in Tanzania: a cohort study

Soledad Colombe, James Beard, Baltazar Mtenga, Peter Lutonja, Julius Mngara, Claudia J. de Dood, Govert J. van Dam, Paul L. A. M. Corstjens, Samuel Kalluvya, Mark Urassa, Jim Todd, Jennifer A. Downs

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Heterosexual transmission is the main driver of the HIV epidemic in Tanzania. Only one estimate of the incidence rate of intra-marital HIV seroconversion in Tanzania has been reported and was derived from data collected between 1991 and 1995. Moreover, little is known about the specific risk factors for intra-marital seroconversion in Tanzania. Improved evidence around factors that increase the risk of HIV transmission to a serodiscordant spouse is needed to develop and improve evidence-based interventions. We sought to investigate the rate of intra-marital HIV seroconversion among HIV sero-discordant couples in Tanzania as well as its associated risk factors. METHODS: We identified all HIV positive individuals in the TAZAMA HIV-serosurvey cohort and followed up their serodiscordant spouse from 2006 to 2016. The rate of seroconversion was analyzed by survival analysis using non-parametric regressions with exponential distribution. RESULTS: We found 105 serodiscordant couples, 14 of which had a seroconverting spouse. The overall HIV-1 incidence rate among spouses of people with HIV-1 infection was 38.0 per 1000 person/years [22.5-64.1]. Notably, the HIV-1 incidence rate among HIV-1 seronegative male spouses was 6.7[0.9-47.5] per 1000 person/years, compared to 59.3 [34.4-102.1] per 1000 person/years among female spouses. Sex of the serodiscordant spouse was the only significant variable, even after adjusting for other variables (Hazard rate = 8.86[1.16-67.70], p = 0.036). CONCLUSIONS: Our study suggests that rates of HIV-1 seroconversion of sero-discordant partners are much higher within marriage than in the general population in Tanzania. The major risk factor for HIV-1 seroconversion is sex of the serodiscordant spouse, with female spouses being at very high risk of acquiring HIV infection. This suggests that future programs that target serodiscordant couples could be a novel and effective means of preventing HIV-1 transmission in Tanzania.
Original languageEnglish
JournalBMC Infectious Diseases
Issue number1
Pages (from-to)518
Number of pages1
Publication statusPublished - 1-Jun-2019


  • Adult
  • Cohort Studies
  • Dried Blood Spot Testing
  • Female
  • Follow-Up Studies
  • Heterosexual behavior
  • Heterosexuality
  • HIV
  • HIV Antibodies
  • HIV Infections
  • HIV-1
  • Humans
  • Incidence
  • Male
  • Modes of transmission
  • Proportional Hazards Models
  • Risk Factors
  • Spouses
  • Tanzania


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