A much higher HIV prevalence was observed in 2008, reaching 49% (95% CI 44–56%) in women delivering at the Manhiça Hospital. Table 1 shows the prevalence by age group for each time-point. Age-specific prevalence showed an upward trend up to 35 years of age, with a peak in women aged 25–29 years, although small sample sizes for older age groups limit conclusions on age-specific prevalence. HIV incidence was estimated at the mid-point between prevalence surveys using two estimation methods and the three epidemic scenarios (described in the Methods section). The incidence results across

all age groups were similar for all four estimation strategies. The highest incidence was observed in younger age groups up to 35 years (results not shown). The overall incidence, after weighting for age group population size, increased over

time (Fig. 1). As shown in the table inset into Figure 1, an increase was observed after 2001, when the incidence was Tanespimycin price approximately 3.5 per 100 person-years, rising to 14 per 100 person-years MAPK inhibitor in 2004, and to over 20 per 100 person-years between 2004 and 2005. In Figure 1, the time regression curve adjusted to the incidence estimation shows an increase in HIV incidence up to 2005, with apparent stabilization thereafter. After omitting one by one each point prevalence in the sensitivity analysis, no significant differences were observed between estimations (results not shown), suggesting consistency of the model. When the upper and lower limits of the incidence rate estimation were calculated for 95% bootstrapping Carnitine palmitoyltransferase II CIs, no significant differences in the limits of the estimations

were observed between the methods (shown only for method 2 in Fig. 1). The results of this analysis show that the prevalence of HIV infection among women of reproductive age in Manhiça, Mozambique has increased significantly in under 10 years. HIV prevalence in this population rose from 12% in 1999 to 49% in 2008. This could be attributable to a sustained increase in HIV incidence or to decreased mortality in HIV-infected individuals. The current results show a significant increase in HIV incidence from 1999 to 2005, and then a plateau from 2005 onwards, despite a steadily increasing prevalence until 2008. These results suggest that the HIV epidemic is in a mature phase in Mozambique. It is important to mention that the two methodologies used to estimate the incidence were in agreement, thus suggesting consistency of the findings [1]. cART was introduced in the Manhiça District Hospital in 2005. It is possible that the introduction and expansion of cART since 2005 might have contributed to a decrease in HIV-related mortality in adults. High cART coverage leads to lower mortality in HIV-infected individuals, thus apparently increasing HIV prevalence despite a stable HIV incidence. However, cART coverage is likely to be low in Manhiça, as has been observed for Mozambique as a whole (24% coverage in 2007) [8].