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Niyongabo A, Villes V, Diagne R, Castro Avila J, Mutima JM, Gakima D, Nimbona P, Niyoncuti E, Rwamuco E, Manirakiza M, Riegel L, Lorente N, Delabre RM, Rojas Castro D. Factors associated with ART interruption during the COVID-19 crisis in Burundi (the EPIC community-based research program). Sci Rep 2024; 14:13187. [PMID: 38851798 PMCID: PMC11162476 DOI: 10.1038/s41598-024-63805-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
With a national prevalence of 0.9%, Burundi is close to achieving UNAIDS' 2025 targets. Despite this, different types of crises periodically disrupt its HIV health services. The community-based program EPIC measured the impact of the COVID-19 health crisis on people living with HIV (PLHIV) in Burundi in 2021. Specifically, it assessed ART interruption and associated factors since the beginning of the pandemic. The study questionnaire was administered to PLHIV in three cities between October and November 2021. Participants were recruited using convenience sampling. Logistic regression models helped identify factors associated with ART interruption. Of the 317 respondents, 37 (11.7%) reported interruption. The majority (79.2%) self-identified as belonging to key populations. Interruption was significantly associated with: fewer HIV medical follow-up visits (adjusted Odds Ratio, aOR = 7.80, p = 0.001) and forced HIV status disclosure (aOR = 4.10, p = 0.004). It was inversely associated with multi-month ART dispensing (aOR = 0.36, p = 0.017) since the beginning of the pandemic and the perception of not having been sufficiently informed by the HIV medical team about the risk of COVID-19 infection (aOR = 0.11, p < 0.001). Our results highlight the importance of multi-month ART dispensing, enhanced communication, and voluntary disclosure of one's HIV status in preventing ART interruption in times of crises in Burundi.
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Affiliation(s)
- Annabelle Niyongabo
- Community-based Research Laboratory, Coalition PLUS, Dakar, Sénégal.
- Association Nationale de Soutien aux Séropositifs et malades du Sida - Santé PLUS (ANSS-Santé PLUS), Bujumbura, Burundi.
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Rokhaya Diagne
- Community-based Research Laboratory, Coalition PLUS, Dakar, Sénégal
| | | | - Jean-Michel Mutima
- Association Nationale de Soutien aux Séropositifs et malades du Sida - Santé PLUS (ANSS-Santé PLUS), Bujumbura, Burundi
| | - Dévote Gakima
- Association Nationale de Soutien aux Séropositifs et malades du Sida - Santé PLUS (ANSS-Santé PLUS), Bujumbura, Burundi
| | - Pélagie Nimbona
- Association Nationale de Soutien aux Séropositifs et malades du Sida - Santé PLUS (ANSS-Santé PLUS), Bujumbura, Burundi
| | - Evangéline Niyoncuti
- Association Nationale de Soutien aux Séropositifs et malades du Sida - Santé PLUS (ANSS-Santé PLUS), Bujumbura, Burundi
| | - Elvis Rwamuco
- Association Nationale de Soutien aux Séropositifs et malades du Sida - Santé PLUS (ANSS-Santé PLUS), Bujumbura, Burundi
| | | | - Lucas Riegel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - Nicolas Lorente
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | | | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
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Pang X, Lu H, He Q, Tang K, Ma J, Chen S, Huang J, Fang N, Xie H, Lan G, Liang S. Emergence of HIV-1 drug resistance mutations among children and adolescents undergoing prolonged antiretroviral therapy in Guangxi. J Glob Antimicrob Resist 2024; 37:208-213. [PMID: 38608935 DOI: 10.1016/j.jgar.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE Antiretroviral therapy (ART) has been implemented in Guangxi for a long time, and there are no reports of HIV drug resistance mutation (DRM) among children and adolescents experiencing virologic failure after ART. This study aimed to analyse HIV DRM prevalence, patterns, and influencing factors among children and adolescents experiencing virologic failure after ART in Guangxi. METHODS We collected samples from a total of 491 HIV-infected individuals under 18 years old experiencing virologic failure after ART from 14 cities in Guangxi. Sequencing and DRM analysis were performed based on pol region. Multivariate logistic regression was employed to analysis the influencing factors of DRM. RESULTS Among these patients, 396 cases were successfully sequenced. Of all, 52.53% exhibited HIV DRM, including NNRTI (48.48%), NRTI (34.85%) and PI (1.01%). NRTI and NNRTI dual-class resistance was prevalent (30.3%). M184V/I and K103N mutations were the common mutations in NRTI and NNRTI, respectively. Male sex (aOR = 2.1, 95% CI: 1.26-3.50), CRF01_AE subtype (OR = 2.50, 95% CI: 1.02-5.88), the primary regimen 3TC+AZT+NVP (OR = 10.00, 95% CI: 5.00-25.00), low pretreatment CD4+ T lymphocytes (<200 cells/mm³) (OR = 1.85, 95% CI: 1.00-3.45), and high viral load (>1000 copies/mL) (OR = 4.90, 95% CI: 1.03-23.39) showed higher risk of DRM. CONCLUSION HIV DRM is pervasive among children and adolescents experiencing virologic failure in Guangxi. Timely HIV DRM monitoring is crucial to mitigate major mutation accumulation and inform effective treatment strategies.
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Affiliation(s)
- Xianwu Pang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Hongyan Lu
- Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China; AIDS Care Clinic, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China
| | - Qin He
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Kailing Tang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Jie Ma
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Siya Chen
- Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China; AIDS Care Clinic, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China
| | - Jinghua Huang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Ningye Fang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Haomin Xie
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China.
| | - Shujia Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Key Laboratory of AIDS Prevention Control and Translation, Guangxi Zhuang Autonomous Region Centre for Disease Control and Prevention, Nanning, Guangxi, China; Guangxi Zhuang Autonomous Region Academy of Preventive Medicine, Nanning, Guangxi, China.
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Telisinghe L, Floyd S, MacLeod D, Schaap A, Dunbar R, Bwalya J, Bell-Mandla N, Piwowar-Manning E, Donnell D, Shaunaube K, Bock P, Fidler S, Hayes RJ, Ayles HM. Incidence of self-reported tuberculosis treatment with community-wide universal testing and treatment for HIV and tuberculosis screening in Zambia and South Africa: A planned analysis of the HPTN 071 (PopART) cluster-randomised trial. PLoS Med 2024; 21:e1004393. [PMID: 38820246 PMCID: PMC11142425 DOI: 10.1371/journal.pmed.1004393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 03/28/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND HIV is a potent risk factor for tuberculosis (TB). Therefore, community-wide universal testing and treatment for HIV (UTT) could contribute to TB control, but evidence for this is limited. Community-wide TB screening can decrease population-level TB prevalence. Combining UTT with TB screening could therefore significantly impact TB control in sub-Saharan Africa, but to our knowledge there is no evidence for this combined approach. METHODS AND FINDINGS HPTN 071 (PopART) was a community-randomised trial conducted between November 2013 to July 2018; 21 Zambian and South African communities (with a total population of approximately 1 million individuals) were randomised to arms A (community-wide UTT and TB screening), B (community-wide universal HIV testing with treatment following national guidelines and TB screening), or C (standard-of-care). In a cohort of randomly selected adults (18 to 44 years) enrolled between 2013 and 2015 from all 21 communities (total size 38,474; 27,139 [71%] female; 8,004 [21%] HIV positive) and followed-up annually for 36 months to measure the population-level impact of the interventions, data on self-reported TB treatment in the previous 12 months (self-reported TB) were collected by trained research assistants and recorded using a structured questionnaire at each study visit. In this prespecified analysis of the trial, self-reported TB incidence rates were measured by calendar year between 2014 and 2017/2018. A p-value ≤0.05 on hypothesis testing was defined as reaching statistical significance. Between January 2014 and July 2018, 38,287 individuals were followed-up: 494 self-reported TB during 104,877 person-years. Overall incidence rates were similar across all arms in 2014 and 2015 (0.33 to 0.46/100 person-years). In 2016 incidence rates were lower in arm A compared to C overall (adjusted rate ratio [aRR] 0.48 [95% confidence interval (95% CI) 0.28 to 0.81; p = 0.01]), with statistical significance reached. In 2017/2018, while incidence rates were lower in arm A compared to C, statistical significance was not reached (aRR 0.58 [95% CI 0.27 to 1.22; p = 0.13]). Among people living with HIV (PLHIV) incidence rates were lower in arm A compared to C in 2016 (RR 0.56 [95% CI 0.29 to 1.08; p = 0.08]) and 2017/2018 (RR 0.50 [95% CI 0.26 to 0.95; p = 0.04]); statistical significance was only reached in 2017/2018. Incidence rates in arms B and C were similar, overall and among PLHIV. Among HIV-negative individuals, there were too few events for cross-arm comparisons. Study limitations include the use of self-report which may have been subject to under-reporting, limited covariate adjustment due to the small number of events, and high losses to follow-up over time. CONCLUSIONS In this study, community-wide UTT and TB screening resulted in substantially lower TB incidence among PLHIV at population-level, compared to standard-of-care, with statistical significance reached in the final study year. There was also some evidence this translated to a decrease in self-reported TB incidence overall in the population. Reduction in arm A but not B suggests UTT drove the observed effect. Our data support the role of UTT in TB control, in addition to HIV control, in high TB/HIV burden settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01900977.
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Affiliation(s)
- L. Telisinghe
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
| | - S. Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - D. MacLeod
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A. Schaap
- Zambart, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - R. Dunbar
- The Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - N. Bell-Mandla
- The Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - E. Piwowar-Manning
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - D. Donnell
- The Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | - P. Bock
- The Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S. Fidler
- Imperial College, London, United Kingdom
- National Institute for Health Research, Imperial Biomedical Research Centre, London, United Kingdom
| | - R. J. Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - H. M. Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Zambart, Lusaka, Zambia
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Mine M, Stafford KA, Laws RL, Marima R, Lekone P, Ramaabya D, Makhaola K, Patel HK, Mapondera P, Wray-Gordon F, Agbakwuru C, Okui L, Matroos S, Onyadile E, Ngidi J, Abimiku A, Bagapi K, Nkomo B, Bodika SM, Kim KJ, Moloney M, Mitchell A, Ehoche A, Ussery FL, Hong SY, Keipeile S, Matlhaga M, Mathumo R, Selato R, Charurat ME, Voetsch AC. Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey. Lancet HIV 2024; 11:e245-e254. [PMID: 38467135 PMCID: PMC11289895 DOI: 10.1016/s2352-3018(24)00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. METHODS BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. FINDINGS The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. INTERPRETATION BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. FUNDING US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rebecca L Laws
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reson Marima
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Phenyo Lekone
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Kgomotso Makhaola
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Hetal K Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Prichard Mapondera
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | - Floris Wray-Gordon
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chinedu Agbakwuru
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana
| | | | | | | | - Alash'le Abimiku
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khuteletso Bagapi
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | | | - Stephane M Bodika
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaylee J Kim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Mirna Moloney
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Mitchell
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akipu Ehoche
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Faith L Ussery
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven Y Hong
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Stella Keipeile
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | | | - Rapetse Mathumo
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | - Robert Selato
- National AIDS and Health Promotion Agency, Gaborone, Botswana
| | - Manhattan E Charurat
- Center for International Health, Education, and Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew C Voetsch
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Silva KRO, Ferreira RC, Coelho LE, Veloso VG, Grinsztejn B, Torres TS, Luz PM. Knowledge of HIV transmission, prevention strategies and U = U among adult sexual and gender minorities in Brazil. J Int AIDS Soc 2024; 27:e26220. [PMID: 38379186 PMCID: PMC10879640 DOI: 10.1002/jia2.26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Although strong scientific evidence of the efficacy and effectiveness of treatment-as-prevention (TasP) is available, full endorsement of the "Undetectable = Untransmittable" (U = U) and "zero-risk" messages could be improved. Increasing knowledge about HIV transmission, prevention and treatment is a critical component of care efforts. The study assessed knowledge of HIV transmission and prevention strategies, and the perceived accuracy of the slogan U = U among sexual and gender minorities (SGM) in Brazil. METHODS Cross-sectional web-based survey targeting adult SGM living in Brazil (2021-2022) recruited on social media and dating apps. We used the 12-item HIV Knowledge Assessment (HIV-KA) questionnaire to assess HIV knowledge, three items of which address pre-exposure prophylaxis (PrEP), post-exposure prophylaxis and TasP. Perceived accuracy of the U = U slogan was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?". We a priori grouped the study population into three mutually exclusive groups: people living with HIV (PLHIV), HIV negative and HIV unknown. We used logistic regression models to assess factors associated with high HIV knowledge and perception of the U = U as completely accurate. RESULTS Of 50,222 individuals accessing the questionnaire, 23,981 were included: 5071 (21.0%) PLHIV, 17,257 (71.5%) HIV negative and 1653 (6.9%) HIV unknown. The proportion of participants with high knowledge was significantly higher for PLHIV and HIV negative (48.1% and 45.5%, respectively) compared to 26.1% of HIV unknown. More PLHIV perceived U = U as completely accurate (80.4%), compared to 60.0% of HIV negative and 42.9% of HIV unknown. HIV knowledge correlates with perceived accuracy of the U = U slogan across all groups. Higher HIV knowledge was associated with higher income and education regardless of HIV status. Among HIV-negative participants, PrEP awareness and use were associated with higher knowledge and accurate perception of the U = U slogan. CONCLUSIONS Our findings show that HIV knowledge and perceived accuracy of U = U are strongly correlated, that knowledge differs according to HIV status, and that poor socio-economic is linked to poor knowledge among SGM from Brazil. Educational strategies regarding TasP, U = U and zero risk targeting socio-economically vulnerable populations are urgent in Brazil.
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Affiliation(s)
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo CruzRio de JaneiroBrazil
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7
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Bogart LM, Phaladze N, Kgotlaetsile K, Goggin KJ, Mosepele M. Qualitative Evaluation of Treatment Partners for People With HIV in Botswana: Current Healthcare Provider Practices and Recommendations for Improvement. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X231225809. [PMID: 38171536 PMCID: PMC11219526 DOI: 10.1177/2752535x231225809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Botswana has an adult HIV prevalence of 20.8% and annual incidence of 0.2%. We aimed to evaluate current practices and advance recommendations for treatment partners (informal adherence supporters) for people with HIV in Botswana. In January-February 2020, we conducted seven focus groups with 36 healthcare providers at seven HIV clinics in Gaborone, Botswana. Providers perceived treatment partners to be critical for quality patient care. They shared that in the new era of universal antiretroviral therapy (ART) initiation immediately after diagnosis ("test-and-treat"), providers no longer require patients to select treatment partners at ART initiation. Providers suggested a renewed emphasis on treatment partners. They believed that standard guidance for providers around treatment partner selection would ensure that providers cover similar topics across patients and endorsed implementation of workshops to educate treatment partners on how to support patients. However, streamlined ART initiation policies require innovative strategies, including eHealth interventions, to engage treatment partners.
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Affiliation(s)
- Laura M. Bogart
- RAND Corporation, Santa Monica, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | | | - Kathy J. Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri - Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
| | - Mosepele Mosepele
- University of Botswana, Gaborone, Botswana
- Botswana Harvard Health Partnership, Gaborone, Botswana
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8
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Monod M, Brizzi A, Galiwango RM, Ssekubugu R, Chen Y, Xi X, Kankaka EN, Ssempijja V, Abeler-Dörner L, Akullian A, Blenkinsop A, Bonsall D, Chang LW, Dan S, Fraser C, Golubchik T, Gray RH, Hall M, Jackson JC, Kigozi G, Laeyendecker O, Mills LA, Quinn TC, Reynolds SJ, Santelli J, Sewankambo NK, Spencer SEF, Ssekasanvu J, Thomson L, Wawer MJ, Serwadda D, Godfrey-Faussett P, Kagaayi J, Grabowski MK, Ratmann O. Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda. Nat Microbiol 2024; 9:35-54. [PMID: 38052974 PMCID: PMC10769880 DOI: 10.1038/s41564-023-01530-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/16/2023] [Indexed: 12/07/2023]
Abstract
HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years. As new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance of 38,749 participants in the Rakai Community Cohort Study and longitudinal deep-sequence viral phylogenetics to assess how HIV incidence and population groups driving transmission have changed from 2003 to 2018 in Uganda. We observed 1,117 individuals in the incidence cohort and 1,978 individuals in the transmission cohort. HIV viral suppression increased more rapidly in women than men, however incidence declined more slowly in women than men. We found that age-specific transmission flows shifted: whereas HIV transmission to girls and women (aged 15-24 years) from older men declined by about one-third, transmission to women (aged 25-34 years) from men that were 0-6 years older increased by half in 2003 to 2018. Based on changes in transmission flows, we estimated that closing the gender gap in viral suppression could have reduced HIV incidence in women by half in 2018. This study suggests that HIV programmes to increase HIV suppression in men are critical to reduce incidence in women, close gender gaps in infection burden and improve men's health in Africa.
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Affiliation(s)
- Mélodie Monod
- Department of Mathematics, Imperial College London, London, UK
| | - Andrea Brizzi
- Department of Mathematics, Imperial College London, London, UK
| | | | | | - Yu Chen
- Department of Mathematics, Imperial College London, London, UK
| | - Xiaoyue Xi
- Department of Mathematics, Imperial College London, London, UK
| | - Edward Nelson Kankaka
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Research Department, Rakai Health Sciences Program, Rakai, Uganda
| | - Victor Ssempijja
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
- Statistics Department, Rakai Health Sciences Program, Rakai, Uganda
| | | | | | | | - David Bonsall
- Wellcome Centre for Human Genomics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shozen Dan
- Department of Mathematics, Imperial College London, London, UK
| | - Christophe Fraser
- Big Data Institute, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, University of Oxford, Oxford, UK
- Sydney Infectious Diseases Institute, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew Hall
- Big Data Institute, University of Oxford, Oxford, UK
| | - Jade C Jackson
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A Mills
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Thomas C Quinn
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven J Reynolds
- Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John Santelli
- Population and Family Health and Pediatrics, Columbia Mailman School of Public Health, New York, NY, USA
| | - Nelson K Sewankambo
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | | | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Thomson
- Big Data Institute, University of Oxford, Oxford, UK
| | - Maria J Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda
- College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda
| | - Peter Godfrey-Faussett
- Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - M Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, UK.
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Monod M, Brizzi A, Galiwango RM, Ssekubugu R, Chen Y, Xi X, Kankaka EN, Ssempijja V, Dörner LA, Akullian A, Blenkinsop A, Bonsall D, Chang LW, Dan S, Fraser C, Golubchik T, Gray RH, Hall M, Jackson JC, Kigozi G, Laeyendecker O, Mills LA, Quinn TC, Reynolds SJ, Santelli J, Sewankambo NK, Spencer SE, Ssekasanvu J, Thomson L, Wawer MJ, Serwadda D, Godfrey-Faussett P, Kagaayi J, Grabowski MK, Ratmann O. Longitudinal population-level HIV epidemiologic and genomic surveillance highlights growing gender disparity of HIV transmission in Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.16.23287351. [PMID: 36993261 PMCID: PMC10055554 DOI: 10.1101/2023.03.16.23287351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
HIV incidence in eastern and southern Africa has historically been concentrated among girls and women aged 15-24 years. As new cases decline with HIV interventions, population-level infection dynamics may shift by age and gender. Here, we integrated population-based surveillance of 38,749 participants in the Rakai Community Cohort Study and longitudinal deep sequence viral phylogenetics to assess how HIV incidence and population groups driving transmission have changed from 2003 to 2018 in Uganda. We observed 1,117 individuals in the incidence cohort and 1,978 individuals in the transmission cohort. HIV viral suppression increased more rapidly in women than men, however incidence declined more slowly in women than men. We found that age-specific transmission flows shifted, while HIV transmission to girls and women (aged 15-24 years) from older men declined by about one third, transmission to women (aged 25-34 years) from men that were 0-6 years older increased by half in 2003 to 2018. Based on changes in transmission flows, we estimated that closing the gender gap in viral suppression could have reduced HIV incidence in women by half in 2018. This study suggests that HIV programs to increase HIV suppression in men are critical to reduce incidence in women, close gender gaps in infection burden and improve men's health in Africa.
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10
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Bogart LM, Phaladze N, Kgotlaetsile K, Klein DJ, Goggin K, Mosepele M. Pilot Test of Mopati, a Multi-Level Adherence Intervention for People Living with HIV and Their Treatment Partners in Botswana. Int J Behav Med 2023:10.1007/s12529-023-10233-7. [PMID: 37957535 PMCID: PMC11089073 DOI: 10.1007/s12529-023-10233-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Low-cost, scalable strategies are necessary to reach the UNAIDS 2030 target of ending HIV as a public health threat. Use of treatment partners, informal caregivers selected by people living with HIV to support antiretroviral therapy adherence, is one such strategy that is included in many countries' HIV guidelines, including Botswana, a country with high HIV prevalence. METHOD From June 2021 to June 2022, we pilot tested a clinic-based treatment partner intervention ("Mopati"), including standardized language for providers to guide patients on treatment partner selection and workshops to train treatment partners on providing non-directive support to patients using a non-confrontational, non-judgmental approach. Sixty unsuppressed patients (30 per clinic) and 45 treatment partners (17 intervention, 28 control) were recruited from an intervention-control clinic matched-pair in Gaborone, Botswana. RESULTS Mopati had medium-to-large effects on increasing patients' adherence, adherence self-efficacy, intrinsic adherence motivation, and perceived non-directive support from treatment partners, and decreasing treatment partner caregiver burden. Aggregate viral suppression rates significantly increased in the intervention (vs. control) clinic. Qualitative data from 14 clinic staff, 21 patients, and 16 treatment partners indicated that Mopati was viewed as effective. Providers said the guidance empowered them to be proactive in communicating about adherence; most reported using the guidance. CONCLUSION This study shows preliminary support for the use of treatment partners in HIV care, and further evidence for interventions that leverage patients' existing support. This research can inform ways to improve adherence to HIV treatment as well as the treatment of HIV-related comorbid conditions in lower-resource settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04796610.
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
| | | | | | - David J Klein
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- Kansas City Schools of Medicine and Pharmacy, University of Missouri, Kansas City, MO, USA
| | - Mosepele Mosepele
- University of Botswana, Gaborone, Botswana
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
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Mulatu G, Gembe M, Chalchisa J, Teklu T, Yismaw W, Dereje D, Wondmagegn H. Isoniazid Preventive Therapy Uptake and Its Effect on Tuberculosis Incidence Among People Living with HIV in Illubabor and Buno Bedelle Zones, South-West Ethiopia, 2022: A Retrospective Cohort Study. HIV AIDS (Auckl) 2023; 15:649-662. [PMID: 37954622 PMCID: PMC10637256 DOI: 10.2147/hiv.s436787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Tuberculosis (TB) remains the leading cause of death among human immune deficiency virus (HIV) patients. Based on the 2020 global TB report, Ethiopia was among the 30 high TB and TB/HIV burden countries. This study filled gaps regarding IPT uptake in the study area and representative sample determination for assessing TB incidence and its predictors at public health facilities in Illubabor and Buno Bedelle zones, south-west Ethiopia. Methods This retrospective cohort study was conducted among people living with HIV (PLHIV) who were on antiretroviral therapy (ART) at public health facilities in Illubabor and Buno Bedelle zones, south-west Ethiopia. Both isoniazid preventive therapy (IPT) exposed and unexposed PLHIV were followed from the date of ART initiation until the date of TB diagnosis of the most recent visit prior to the end of follow-up. The Cox proportional hazard model was employed to identify variables that predicted the incidence of TB at a P value of <0.05. Results Data were collected on 421 PLHIV, with a response rate of 97.4%. The median (interquartile range (IQR)) age of the study participants was 32 (28-40) year. The incidence rate of pulmonary TB was 3.1 per 1000 person-months (95% CI: 2.4-3.9). The incidence rate of TB among IPT-exposed PLHIV was 1.45 per 1000 person-months, but it was 6.2 per 1000 person-months in the unexposed group. Patient's residence, IPT exposure, baseline ART adherence, baseline hemoglobin level, baseline CD4+ cell, recent hemoglobin level, recent CD4+ cell, recent BMI, and recent WHO HIV clinical stage were independently associated with the incidence of TB. Conclusion Healthcare professionals working in ART clinics should routinely assess HIV-positive individuals for changes in clinical indicators and environmental exposures like living conditions, which will help HIV-positive individuals in reducing their risk for TB. Likewise, patients attending ART clinics should receive counseling on a regular basis.
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Affiliation(s)
- Gebremeskel Mulatu
- Department of Nursing, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Maycas Gembe
- Department of Nursing, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Jiregna Chalchisa
- Department of Nursing, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Tigist Teklu
- Department of Nursing, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Worke Yismaw
- Department of Nursing, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Debela Dereje
- Department of Nursing, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Habtamu Wondmagegn
- Department of Anatomy, School of Medicine, Arba Minch University, Arba Minch, Ethiopia
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12
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Labhardt ND, Brown JA, Sass N, Ford N, Rosen S. Treatment Outcomes After Offering Same-Day Initiation of Human Immunodeficiency Virus Treatment-How to Interpret Discrepancies Between Different Studies. Clin Infect Dis 2023; 77:1176-1184. [PMID: 37229594 PMCID: PMC10573746 DOI: 10.1093/cid/ciad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
The World Health Organization recommends same-day initiation of antiretroviral therapy (ART) for all persons diagnosed with HIV and ready to start treatment. Evidence, mainly from randomized trials, indicates offering same-day ART increases engagement in care and viral suppression during the first year. In contrast, most observational studies using routine data find same-day ART to be associated with lower engagement in care. We argue that this discrepancy is mainly driven by different time points of enrollment, leading to different denominators. While randomized trials enroll individuals when tested positive, most observational studies start at the time point when ART is initiated. Thus, most observational studies omit those who are lost between diagnosis and treatment, thereby introducing a selection bias in the group with delayed ART. This viewpoint article summarizes the available evidence and argues that the benefits of same-day ART outweigh a potential higher risk of attrition from care after ART initiation.
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Affiliation(s)
- Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Jennifer Anne Brown
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nikita Sass
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nathan Ford
- Department of HIV, Hepatitis, and Sexually Transmitted Infections, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sydney Rosen
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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13
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Hamooya BM, Mutembo S, Muyunda B, Mweebo K, Kancheya N, Sikazwe L, Sakala M, Mvula J, Kunda S, Kabesha S, Cheelo C, Fwemba I, Banda C, Masenga SK. HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study. Front Public Health 2023; 11:1244125. [PMID: 37900026 PMCID: PMC10600392 DOI: 10.3389/fpubh.2023.1244125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Globally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy. Methods We conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model). Results The median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p < 0.001. The reasons for attrition were higher in the BTT compared to the ATT cohorts: stopped treatment (0.3 vs. 0.1%), transferred out (9.3 vs. 3.2%), lost to follow-up (13.5 vs. 5.9%), and death (1.4 vs. 0.2%). Retention in care was significantly associated with the ATT cohort, increasing age and baseline body mass index (BMI), rural residence, and WHO stage 2, while non-retention was associated with never being married, divorced, and being in WHO stage 3. Conclusion The retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy.
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Affiliation(s)
- Benson M. Hamooya
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
| | - Simon Mutembo
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Brian Muyunda
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Keith Mweebo
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Nzali Kancheya
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Lyapa Sikazwe
- Provincial Medical Office, Ministry of Health, Choma, Zambia
| | - Morgan Sakala
- Provincial Medical Office, Ministry of Health, Choma, Zambia
| | - Johanzi Mvula
- Provincial Medical Office, Ministry of Health, Choma, Zambia
| | - Salazeh Kunda
- Provincial Medical Office, Ministry of Health, Choma, Zambia
| | - Shem Kabesha
- Provincial Medical Office, Ministry of Health, Choma, Zambia
| | - Chilala Cheelo
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
| | - Isaac Fwemba
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Clive Banda
- Provincial Medical Office, Ministry of Health, Choma, Zambia
| | - Sepiso K. Masenga
- School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
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14
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Haile Hantalo A, Tantu Arusi T, Kolato Koche S. Level of Antiretroviral Therapy Adherence and Associated Factors Among People Living with HIV in the Context of Early Antiretroviral Therapy Initiation in Wolaita Sodo Town, Ethiopia: Cross-Sectional Study. AIDS Res Hum Retroviruses 2023; 39:518-524. [PMID: 37243444 DOI: 10.1089/aid.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Early antiretroviral therapy (ART) initiation is WHO recommendation to fasten viral suppression and for prevention of further viral transmission sexually. There is no evidence showing the level of adherence to ART after initiation of the universal test and treat (UTT) strategy in Ethiopia, including study area. This study was aimed to determine the level of ART adherence and associated factors among HIV/AIDS patients in context of UTT strategy. A health facility-based study was conducted on 352 people living with HIV who started their ART follow-up after application of UTT strategy in Ethiopia from April 15 to June 5, 2020. Systematic random sampling method was used to select the study participants. Interviewer administered questionnaire was used to collect data and the collected data were entered directly in to SPSS version 21 and analyzed. Both bivariate and multivariate logistic regression analyses were carried out. Strength and direction of association was determined by using adjusted odds ratio (AOR) with 95% confidence interval. The total 352 participants included the study. The overall level of adherence was 290 (82.4%). Commonly used ART regimen was TDF +3TC+EFV, 201 (57.1%). In bivariate analysis, type of health institutions, crude odds ratio (COR) = 2.934 (1.388-6.200), age level of 18-27 years, COR = 0.357 (0.133-0.959), current viral load of 3log scale, COR = 0.357 (0.133-0.959), and change of ART medication, COR = 8.088 (1.973-33.165) were associated with medication adherence. Health institution type AOR = 2.615 (1.147-5.9600) and change of ART medication, AOR = 7.267 (1.683-31.384) were independent predictors of ART adherence. Low level of ART adherence was detected in this study. It was below the recommended good adherence standard and 90-90-90 target strategy. Therefore, patients should get adequate and comprehensive ART adherence counseling before initiation of ART treatment and during the follow-up time.
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Affiliation(s)
- Admasu Haile Hantalo
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Tantu Arusi
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Sitotaw Kolato Koche
- Department of Medical Laboratory Science, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Klinkenberg E, Floyd S, Shanaube K, Mureithi L, Gachie T, de Haas P, Kosloff B, Dodd PJ, Ruperez M, Wapamesa C, Burnett JM, Kalisvaart N, Kasese N, Vermaak R, Schaap A, Fidler S, Hayes R, Ayles H. Tuberculosis prevalence after 4 years of population-wide systematic TB symptom screening and universal testing and treatment for HIV in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: A cross-sectional survey (TREATS). PLoS Med 2023; 20:e1004278. [PMID: 37682971 PMCID: PMC10490889 DOI: 10.1371/journal.pmed.1004278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/27/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) prevalence remains persistently high in many settings, with new or expanded interventions required to achieve substantial reductions. The HIV Prevention Trials Network (HPTN) 071 (PopART) community-randomised trial randomised 14 communities to receive the "PopART" intervention during 2014 to 2017 (7 arm A and 7 arm B communities) and 7 communities to receive standard-of-care (arm C). The intervention was delivered door-to-door by community HIV care providers (CHiPs) and included universal HIV testing, facilitated linkage to HIV care at government health clinics, and systematic TB symptom screening. The Tuberculosis Reduction through Expanded Anti-retroviral Treatment and Screening (TREATS) study aimed to measure the impact of delivering the PopART intervention on TB outcomes, in communities with high HIV and TB prevalence. METHODS AND FINDINGS The study population of the HPTN 071 (PopART) trial included individuals aged ≥15 years living in 21 urban and peri-urban communities in Zambia and South Africa, with a total population of approximately 1 million and an adult HIV prevalence of around 15% at the time of the trial. Two sputum samples for TB testing were provided to CHiPs by individuals who reported ≥1 TB suggestive symptom (a cough for ≥2 weeks, unintentional weight loss ≥1.5 kg in the last month, or current night sweats) or that a household member was currently on TB treatment. Antiretroviral therapy (ART) was offered universally at clinics in arm A and according to local guidelines in arms B and C. The TREATS study was conducted in the same 21 communities as the HPTN 071 (PopART) trial between 2017 and 2022, and TB prevalence was a co-primary endpoint of the TREATS study. The primary comparison was between the PopART intervention (arms A and B combined) and the standard-of-care (arm C). During 2019 to 2021, a TB prevalence survey was conducted among randomly selected individuals aged ≥15 years (approximately 1,750 per community in arms A and B, approximately 3,500 in arm C). Participants were screened on TB symptoms and chest X-ray, with diagnostic testing using Xpert-Ultra followed by culture for individuals who screened positive. Sputum eligibility was determined by the presence of a cough for ≥2 weeks, or ≥2 of 5 "TB suggestive" symptoms (cough, weight loss for ≥4 weeks, night sweats, chest pain, and fever for ≥2 weeks), or chest X-ray CAD4TBv5 score ≥50, or no available X-ray results. TB prevalence was compared between trial arms using standard methods for cluster-randomised trials, with adjustment for age, sex, and HIV status, and multiple imputation was used for missing data on prevalent TB. Among 83,092 individuals who were eligible for the survey, 49,556 (59.6%) participated, 8,083 (16.3%) screened positive, 90.8% (7,336/8,083) provided 2 sputum samples for Xpert-Ultra testing, and 308 (4.2%) required culture confirmation. Overall, estimated TB prevalence was 0.92% (457/49,556). The geometric means of 7 community-level prevalence estimates were 0.91%, 0.70%, and 0.69% in arms A, B, and C, respectively, with no evidence of a difference comparing arms A and B combined with arm C (adjusted prevalence ratio 1.14, 95% confidence interval, CI [0.67, 1.95], p = 0.60). TB prevalence was higher among people living with HIV than HIV-negative individuals, with an age-sex-community adjusted odds ratio of 2.29 [95% CI 1.54, 3.41] in Zambian communities and 1.61 [95% CI 1.13, 2.30] in South African communities. The primary limitations are that the study was powered to detect only large reductions in TB prevalence in the intervention arm compared with standard-of-care, and the between-community variation in TB prevalence was larger than anticipated. CONCLUSIONS There was no evidence that the PopART intervention reduced TB prevalence. Systematic screening for TB that is based on symptom screening alone may not be sufficient to achieve a large reduction in TB prevalence over a period of several years. Including chest X-ray screening alongside TB symptom screening could substantially increase the sensitivity of systematic screening for TB. TRIAL REGISTRATION The TREATS study was registered with ClinicalTrials.gov Identifier: NCT03739736 on November 14, 2018. The HPTN 071 (PopART) trial was registered at ClinicalTrials.gov under number NCT01900977 on July 17, 2013.
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Affiliation(s)
- Eveline Klinkenberg
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, the Netherlands
- KNCV Tuberculosis Foundation, Hague, the Netherlands
| | - Sian Floyd
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Kwame Shanaube
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | | | - Thomas Gachie
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Petra de Haas
- KNCV Tuberculosis Foundation, Hague, the Netherlands
| | - Barry Kosloff
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Peter J. Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Maria Ruperez
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Chali Wapamesa
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | | | | | - Nkatya Kasese
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | | | - Albertus Schaap
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Sarah Fidler
- HIV Clinical Trials Unit, Imperial College London, London, United Kingdom
| | - Richard Hayes
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Helen Ayles
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
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Davis K, Pickles M, Gregson S, Hargreaves JR, Ayles H, Bock P, Pliakas T, Thomas R, Ohrnberger J, Bwalya J, Bell-Mandla N, Shanaube K, Probert W, Hoddinott G, Bond V, Hayes R, Fidler S, Hauck K. The effect of universal testing and treatment for HIV on health-related quality of life - An analysis of data from the HPTN 071 (PopART) cluster randomised trial. SSM Popul Health 2023; 23:101473. [PMID: 37575363 PMCID: PMC10413193 DOI: 10.1016/j.ssmph.2023.101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Background HIV treatment has clear Health-Related Quality-of-Life (HRQoL) benefits. However, little is known about how Universal Testing and Treatment (UTT) for HIV affects HRQoL. This study aimed to examine the effect of a combination prevention intervention, including UTT, on HRQoL among People Living with HIV (PLHIV). Methods Data were from HPTN 071 (PopART), a three-arm cluster randomised controlled trial in 21 communities in Zambia and South Africa (2013-2018). Arm A received the full UTT intervention of door-to-door HIV testing plus access to antiretroviral therapy (ART) regardless of CD4 count, Arm B received the intervention but followed national treatment guidelines (universal ART from 2016), and Arm C received standard care. The intervention effect was measured in a cohort of randomly selected adults, over 36 months. HRQoL scores, and the prevalence of problems in five HRQoL dimensions (mobility, self-care, performing daily activities, pain/discomfort, anxiety/depression) were assessed among all participants using the EuroQol-5-dimensions-5-levels questionnaire (EQ-5D-5L). We compared HRQoL among PLHIV with laboratory confirmed HIV status between arms, using adjusted two-stage cluster-level analyses. Results At baseline, 7,856 PLHIV provided HRQoL data. At 36 months, the mean HRQoL score was 0.892 (95% confidence interval: 0.887-0.898) in Arm A, 0.886 (0.877-0.894) in Arm B and 0.888 (0.884-0.892) in Arm C. There was no evidence of a difference in HRQoL scores between arms (A vs C, adjusted mean difference: 0.003, -0.001-0.006; B vs C: -0.004, -0.014-0.005). The prevalence of problems with pain/discomfort was lower in Arm A than C (adjusted prevalence ratio: 0.37, 0.14-0.97). There was no evidence of differences for other HRQoL dimensions. Conclusions The intervention did not change overall HRQoL, suggesting that raising HRQoL among PLHIV might require more than improved testing and treatment. However, PLHIV had fewer problems with pain/discomfort under the full intervention; this benefit of UTT should be maximised during roll-out.
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Affiliation(s)
- Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Michael Pickles
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ranjeeta Thomas
- Department of Health Policy, London School of Economics, London, WC2A 2AE, UK
| | - Julius Ohrnberger
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Justin Bwalya
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Kwame Shanaube
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - William Probert
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - the HPTN 071 (PopART) Study Team
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
- Department of Health Policy, London School of Economics, London, WC2A 2AE, UK
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK
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Makurumidze R, Decroo T, Jacobs BKM, Rusakaniko S, Van Damme W, Lynen L, Gils T. Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV "Treat All" in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:558. [PMID: 37641003 PMCID: PMC10463759 DOI: 10.1186/s12879-023-08551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Evidence on the real-world effects of "Treat All" on attrition has not been systematically reviewed. We aimed to review existing literature to compare attrition 12 months after antiretroviral therapy (ART) initiation, before and after "Treat All" was implemented in Sub-Saharan Africa and describe predictors of attrition. METHODS We searched Embase, Google Scholar, PubMed, and Web of Science in July 2020 and created alerts up to the end of June 2023. We also searched for preprints and conference abstracts. Two co-authors screened and selected the articles. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. We extracted and tabulated data on study characteristics, attrition 12 months after ART initiation, and predictors of attrition. We calculated a pooled risk ratio for attrition using random-effects meta-analysis. RESULTS Eight articles and one conference abstract (nine studies) out of 8179 screened records were included in the meta-analysis. The random-effects adjusted pooled risk ratio (RR) comparing attrition before and after "Treat All" 12 months after ART initiation was not significant [RR = 1.07 (95% Confidence interval (CI): 0.91-1.24)], with 92% heterogeneity (I2). Being a pregnant or breastfeeding woman, starting ART with advanced HIV, and starting ART within the same week were reported as risk factors for attrition both before and after "Treat All". CONCLUSIONS We found no significant difference in attrition before and after "Treat All" one year after ART initiation. While "Treat All" is being implemented widely, differentiated approaches to enhance retention should be prioritised for those subgroups at risk of attrition. PROSPERO NUMBER CRD42020191582 .
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Affiliation(s)
- Richard Makurumidze
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium.
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe.
- Faculty of Medicine & Pharmacy, Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Tom Decroo
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Research Foundation of Flanders, Brussels, Belgium
| | - Bart K M Jacobs
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | - Simbarashe Rusakaniko
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Wim Van Damme
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Faculty of Medicine & Pharmacy, Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lutgarde Lynen
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | - Tinne Gils
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Global Health Institute, University of Antwerp, Antwerp, Belgium
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18
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Kebede HK, Gesesew H, Ward P. Impact of armed conflicts on HIV treatment outcomes in sub-Saharan Africa: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e069308. [PMID: 37558447 PMCID: PMC10414123 DOI: 10.1136/bmjopen-2022-069308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Armed conflicts have significant negative impacts on the entire healthcare system in general and HIV care system in particular. Sub-Saharan Africa is suffering from a disproportionate double burden of armed conflict and HIV infection. Nevertheless, the impact of the armed conflict on the HIV treatment outcomes in conflict settings in sub-Saharan Africa has not been thoroughly and systematically synthesised. This protocol outlines a review that aims to summarise the available evidence on the impact of armed conflict on HIV treatment outcomes in sub-Saharan Africa. METHODS AND ANALYSIS A systematic review of all quantitative studies that assess the impact of armed conflicts on HIV treatment outcomes will be conducted. The systematic search will start with a preliminary search of Google Scholar, followed by implementation of the full search strategy across five databases (MEDLINE, PubMed, CINAHL, SCOPUS and Web of Science) and the screening of titles and abstracts then relevant full texts. Bibliographies will be reviewed to identify additional relevant studies. We will include studies conducted in sub-Saharan Africa that were published in English between 1 January 2002 and 31 December 2022. Methodological validity of the included studies will be assessed using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument. Data will be extracted using standardised JBI instruments and analysed through narrative synthesis, and meta-analyses and regression. Heterogeneity will be assessed using I2 and Χ2 tests. ETHICS AND DISSEMINATION Since this study will not involve gathering primary data, formal ethical approval is not required. Journal publications, conference presentations and a media release will be used to share the study findings. PROSPERO REGISTRATION NUMBER CRD42022361924.
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Affiliation(s)
- Hafte Kahsay Kebede
- Pharmacy school, Mekelle University, Mekelle, Ethiopia
- Research center for Public Health, Equity, and Human Flourshing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- Epidemiology, Mekelle University, Mekelle, Ethiopia
- Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Paul Ward
- Research center for Public Health, Equity, and Human Flourshing, Torrens University Australia, Adelaide, South Australia, Australia
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De Cock KM, El-Sadr WM. Invisible, but not absent. AIDS 2023; 37:N3-N6. [PMID: 37395249 DOI: 10.1097/qad.0000000000003580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
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20
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Larmarange J, Bachanas P, Skalland T, Balzer LB, Iwuji C, Floyd S, Mills LA, Pillay D, Havlir D, Kamya MR, Ayles H, Wirth K, Dabis F, Hayes R, Petersen M. Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002157. [PMID: 37450436 PMCID: PMC10348573 DOI: 10.1371/journal.pgph.0002157] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
Universal HIV testing and treatment (UTT) strategies aim to optimize population-level benefits of antiretroviral treatment. Between 2012 and 2018, four large community randomized trials were conducted in eastern and southern Africa. While their results were broadly consistent showing decreased population-level viremia reduces HIV incidence, it remains unclear how much HIV incidence can be reduced by increasing suppression among people living with HIV (PLHIV). We conducted a pooled analysis across the four UTT trials. Leveraging data from 105 communities in five countries, we evaluated the linear relationship between i) population-level viremia (prevalence of non-suppression-defined as plasma HIV RNA >500 or >400 copies/mL-among all adults, irrespective of HIV status) and HIV incidence; and ii) prevalence of non-suppression among PLHIV and HIV incidence, using parametric g-computation. HIV prevalence, measured in 257 929 persons, varied from 2 to 41% across the communities; prevalence of non-suppression among PLHIV, measured in 31 377 persons, from 3 to 70%; population-level viremia, derived from HIV prevalence and non-suppression, from < 1% to 25%; and HIV incidence, measured over 345 844 person-years (PY), from 0.03/100PY to 3.46/100PY. Decreases in population-level viremia were strongly associated with decreased HIV incidence in all trials (between 0.45/100PY and 1.88/100PY decline in HIV incidence per 10 percentage points decline in viremia). Decreases in non-suppression among PLHIV were also associated with decreased HIV incidence in all trials (between 0.06/100PY and 0.17/100PY decline in HIV incidence per 10 percentage points decline in non-suppression). Our results support both the utility of population-level viremia as a predictor of incidence, and thus a tool for targeting prevention interventions, and the ability of UTT approaches to reduce HIV incidence by increasing viral suppression. Implementation of universal HIV testing approaches, coupled with interventions to leverage linkage to treatment, adapted to local contexts, can reduce HIV acquisition at population level.
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Affiliation(s)
- Joseph Larmarange
- Centre Population et Développement, Université Paris Cité, IRD, Inserm, Paris, France
| | - Pamela Bachanas
- Division of Global HIV/AIDS and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Timothy Skalland
- Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Laura B. Balzer
- Division of Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lisa A. Mills
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Deenan Pillay
- Division of Infection & Immunity, University College London, London, United Kingdom
| | - Diane Havlir
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University Kampala, Uganda and the Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Helen Ayles
- Clinical Research Department London School of Hygiene & Tropical Medicine, London, United Kingdom
- Zambart, University of Zambia School of Public Health, Lusaka, Zambia
| | - Kathleen Wirth
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - François Dabis
- Université Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
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Hardiawan D, Juwita MN, Vadra J, Prawiranegara R, Mambea IY, Wisaksana R, Handayani M, Subronto YW, Kusmayanti NA, Januraga P, Sukmaningrum E, Nurhayati, Prameswari HD, Sulaiman N, Siregar AYM. Cost of improved test and treat strategies in Indonesia. AIDS 2023; 37:1189-1201. [PMID: 36927656 DOI: 10.1097/qad.0000000000003547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To estimate and compare the cost of improved test and treat strategies in Indonesia under HIV Awal (Early) Testing and Treatment Indonesia (HATI) implementation trial in community-based and hospital-based clinics. DESIGN The cost and outcome [i.e. CD4 + cell count] and viral load (VL) at the beginning of interventions and their change overtime) analysis of Simplifying ART Initiation (SAI), Community-based Organization and community-based ART Service (CBO), Motivational Interviewing (MI), Oral Fluid-based Testing (OFT), and Short Message Service (SMS) reminder in community-based and hospital-based clinics in 2018-2019. METHOD We estimated the total and unit costs per patient (under HATI implementation trial interventions) per year from societal perspective in various settings, including costs from patients' perspective for SAI and MI. We also analyzed the outcome variables (i.e. CD4 + cell count and VL at the beginning of each intervention, the change in CD4 + cell count and VL over time, and adherence rate). RESULT The unit cost per patient per year of SAI and SMS were lower at the community-based clinics, and more patients visited community-based clinics. The cost per patient visit from patient perspective for SAI and MI was mostly lower than 10% of the patients' household monthly expenditure. Average CD4 + cell count was higher and average VL was lower at the start of interventions at the community-based clinics, while average CD4 + cell count and VL changes and adherence rate were similar between the two types of clinics. CONCLUSION Community-based clinics hold the potential for scaling up the interventions as it costs less from societal perspective and showed better outcome improvement during the HATI implementation trial.
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Affiliation(s)
- Donny Hardiawan
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran
| | - Mery N Juwita
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran
| | - Jorghi Vadra
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran
| | - Rozar Prawiranegara
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran
| | - Indra Y Mambea
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran
| | - Rudi Wisaksana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran
| | - Miasari Handayani
- Research Centre for Care and Control of Infectious Disease, Universitas Padjadjaran
| | - Yanri W Subronto
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada
| | - Nur A Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada
| | - Pande Januraga
- Center for Public Health Innovation, Faculty of Medicine, Udayana University
| | - Evi Sukmaningrum
- University Center of Excellence - AIDS Research Center Health Policy and Social Innovation, Atma Jaya Catholic University of Indonesia
| | - Nurhayati
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia
| | | | | | - Adiatma Y M Siregar
- Center for Economics and Development Studies (CEDS), Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran
- Center for Health Technology Assessment (CHTA), Universitas Padjadjaran
- West Java Development Institute (INJABAR), Universitas Padjadjaran, Indonesia
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22
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Hladik W, Stupp P, McCracken SD, Justman J, Ndongmo C, Shang J, Dokubo EK, Gummerson E, Koui I, Bodika S, Lobognon R, Brou H, Ryan C, Brown K, Nuwagaba-Biribonwoha H, Kingwara L, Young P, Bronson M, Chege D, Malewo O, Mengistu Y, Koen F, Jahn A, Auld A, Jonnalagadda S, Radin E, Hamunime N, Williams DB, Kayirangwa E, Mugisha V, Mdodo R, Delgado S, Kirungi W, Nelson L, West C, Biraro S, Dzekedzeke K, Barradas D, Mugurungi O, Balachandra S, Kilmarx PH, Musuka G, Patel H, Parekh B, Sleeman K, Domaoal RA, Rutherford G, Motsoane T, Bissek ACZK, Farahani M, Voetsch AC. The epidemiology of HIV population viral load in twelve sub-Saharan African countries. PLoS One 2023; 18:e0275560. [PMID: 37363921 DOI: 10.1371/journal.pone.0275560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries. METHODS We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d'Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (<1,000 HIV-1 RNA copies/mL) and with unsuppressed viral load (viremic), the prevalence of unsuppressed HIV (population viremia), sex-specific HIV transmission ratios (number female incident HIV-1 infections/number unsuppressed male PLHIV per 100 persons-years [PY] and vice versa) and examined correlations between a variety of VL metrics and incident HIV. Country sample sizes ranged from 10,016 (Eswatini) to 30,637 (Rwanda); estimates were weighted and restricted to participants 15 years and older. RESULTS The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries' total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3-28.3/100 PY) than for female-to-male transmission (range: 1.5-10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92). CONCLUSIONS Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries' total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries.
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Affiliation(s)
- Wolfgang Hladik
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Paul Stupp
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Stephen D McCracken
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Jessica Justman
- ICAP at Columbia University, New York, New York, United States of America
| | - Clement Ndongmo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Judith Shang
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Emily K Dokubo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | | | | | - Stephane Bodika
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Roger Lobognon
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Hermann Brou
- ICAP at Columbia University, New York, New York, United States of America
| | - Caroline Ryan
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Kristin Brown
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | | | - Leonard Kingwara
- National AIDS and STI's Control Programme, Ministry of Health, Nairobi, Kenya
| | - Peter Young
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Megan Bronson
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Duncan Chege
- ICAP at Columbia University, New York, New York, United States of America
| | - Optatus Malewo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Yohannes Mengistu
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Frederix Koen
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Andrew Auld
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Elizabeth Radin
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Daniel B Williams
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Eugenie Kayirangwa
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Veronicah Mugisha
- ICAP at Columbia University, New York, New York, United States of America
| | - Rennatus Mdodo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Stephen Delgado
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Lisa Nelson
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Christine West
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Samuel Biraro
- ICAP at Columbia University, New York, New York, United States of America
| | | | - Danielle Barradas
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | | | - Shirish Balachandra
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Peter H Kilmarx
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Godfrey Musuka
- ICAP at Columbia University, New York, New York, United States of America
| | - Hetal Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Bharat Parekh
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Katrina Sleeman
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - Robert A Domaoal
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - George Rutherford
- University of California San Francisco, San Francisco, California, United States of America
| | | | - Anne-Cécile Zoung-Kanyi Bissek
- Division of Operational Research for Health, Ministry of Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Mansoor Farahani
- ICAP at Columbia University, New York, New York, United States of America
| | - Andrew C Voetsch
- Division of Global HIV and TB, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
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23
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Rosen JG, Muraleetharan O, Walker A, Srivastava M. Pediatric Antiretroviral Therapy Coverage and AIDS Deaths in the "Treat All" Era. Pediatrics 2023; 151:e2022059013. [PMID: 37194480 PMCID: PMC10829847 DOI: 10.1542/peds.2022-059013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES In 2015, CD4-based clinical staging criteria for antiretroviral therapy (ART) initiation were removed, expanding ART eligibility ("Treat All") for children, who shoulder an outsized burden of HIV-related deaths. To quantify the impact of "Treat All" on pediatric HIV outcomes, we examined shifts in pediatric ART coverage and AIDS mortality before and after "Treat All" implementation. METHODS We abstracted country-level ART coverage (proportion of children <15 years on ART) and AIDS mortality (deaths per 100 000 population) estimates over 11 years. For 91 countries, we also abstracted the year "Treat All" was incorporated into national guidelines. We used multivariable 2-way fixed effects negative binomial regression to estimate changes in pediatric ART coverage and AIDS mortality potentially attributable to "Treat All" expansion, reported as adjusted incidence rate ratios (adj.IRR) with 95% confidence intervals (95% CI). RESULTS From 2010 to 2020, pediatric ART coverage tripled (16% to 54%), and AIDS-related deaths were halved (240 000 to 99 000). Compared with the pre-implementation period, observed ART coverage continued increasing after "Treat All" adoption, but this rate of increase declined by 6% (adj.IRR = 0.94, 95% CI: 0.91-0.98). AIDS mortality continued declining after "Treat All" adoption, but this rate of decline decreased by 8% (adj.IRR = 1.08, 95% CI: 1.05-1.11) in the post-implementation period. CONCLUSIONS Although "Treat All" called for increased HIV treatment equity, ART coverage continues lagging in children and comprehensive approaches that address structural issues, including family-based services and intensified case-finding, are needed to close pediatric HIV treatment gaps.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ohvia Muraleetharan
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia
| | - Allison Walker
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia
| | - Meena Srivastava
- Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia
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24
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Hontelez JAC, Nagelkerke NJD, De Vlas SJ. HIV treatment as prevention: Bound to disappoint? Trop Med Int Health 2023; 28:158-161. [PMID: 36661311 DOI: 10.1111/tmi.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Jan A C Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany
| | - Nico J D Nagelkerke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J De Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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25
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Young PW, Musingila P, Kingwara L, Voetsch AC, Zielinski-Gutierrez E, Bulterys M, Kim AA, Bronson MA, Parekh BS, Dobbs T, Patel H, Reid G, Achia T, Keter A, Mwalili S, Ogollah FM, Ondondo R, Longwe H, Chege D, Bowen N, Umuro M, Ngugi C, Justman J, Cherutich P, De Cock KM. HIV Incidence, Recent HIV Infection, and Associated Factors, Kenya, 2007-2018. AIDS Res Hum Retroviruses 2023; 39:57-67. [PMID: 36401361 PMCID: PMC9942172 DOI: 10.1089/aid.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use. We assessed factors associated with recent and long-term (≥12 months) HIV infection versus no infection using a multinomial logit model while accounting for complex survey design. Of 1,523 HIV-positive participants in 2018, 11 were classified as recent. Annual HIV incidence was 0.14% in 2018 [95% confidence interval (CI) 0.057-0.23], representing 35,900 (95% CI 16,300-55,600) new infections per year in Kenya among persons aged 15-64 years. The percentage of HIV infections that were determined to be recent was similar in 2007 and 2012 but fell significantly from 2012 to 2018 [adjusted odds ratio (aOR) = 0.31, p < .001]. Compared to no HIV infection, being aged 25-34 versus 35-64 years (aOR = 4.2, 95% CI 1.4-13), having more lifetime sex partners (aOR = 5.2, 95% CI 1.6-17 for 2-3 partners and aOR = 8.6, 95% CI 2.8-26 for ≥4 partners vs. 0-1 partners), and never having tested for HIV (aOR = 4.1, 95% CI 1.5-11) were independently associated with recent HIV infection. Although HIV remains a public health priority in Kenya, HIV incidence estimates and trends in recent HIV infection support a significant decrease in new HIV infections from 2012 to 2018, a period of rapid expansion in HIV diagnosis, prevention, and treatment.
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Affiliation(s)
- Peter Wesley Young
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique.,Address correspondence to: Peter Wesley Young, U.S. Embassy Maputo, Avenida Marginal nr 5467, Sommerschield, Distrito Municipal de KaMpfumo, Caixa Postal 783, CEP 0101-11 Maputo, Mozambique
| | - Paul Musingila
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Kingwara
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Andrew C. Voetsch
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya.,Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Marc Bulterys
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan A. Bronson
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharat S. Parekh
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hetal Patel
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Giles Reid
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Thomas Achia
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Alfred Keter
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Samuel Mwalili
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Raphael Ondondo
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Herbert Longwe
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Duncan Chege
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Nancy Bowen
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | - Mamo Umuro
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | | | - Jessica Justman
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | | | - Kevin M. De Cock
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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26
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Govender K, Long L, Miot J. Progress towards unique patient identification and case-based surveillance within the Southern African development community. Health Informatics J 2023; 29:14604582221139058. [PMID: 36601790 DOI: 10.1177/14604582221139058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Population mobility makes patient-tracking and care linkage in the South African Development Community (SADC) challenging. Case-based surveillance (CBS) through individual-level clinical data linked with a unique patient-identifier (UPI) is recommended. We conducted a mixed-methods landscape analysis of UPI and CBS implementation within selected SADC countries, this included: (1) SADC UPI implementation literature review; (2) assessment of UPI and CBS implementation for high HIV-prevalence SADC countries; (3) UPI implementation case-study in selected South African primary healthcare (PHC) facilities. Research into CBS and UPI implementation for the SADC region is lacking. Existing patient-identification methods often fail and limit patient-tracking. Paper-based records and poor integration between health-information systems further restrict patient-tracking. Most countries were in the early-middle stages of CBS and faced UPI challenges. Our South African case-study found that the UPI often goes uncaptured. Difficulties tracking patients across prevention and care cascades will continue until a functional and reliable UPI is available.
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Affiliation(s)
- Kerensa Govender
- Faculty of Health Sciences, 37708University of the Witwatersrand, Johannesburg, South Africa; Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, 37708University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Faculty of Health Sciences, 37708University of the Witwatersrand, Johannesburg, South Africa; Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, 37708University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, 27118Boston University School of Public Health, Boston, MA, USA
| | - Jacqui Miot
- Faculty of Health Sciences, 37708University of the Witwatersrand, Johannesburg, South Africa; Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, 37708University of the Witwatersrand, Johannesburg, South Africa
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27
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Gómez-Olivé FX, Scheuermaier K. Alarming high prevalence of non-HIV sexually transmitted infections in a rural population of Southern Uganda. Lancet Glob Health 2022; 10:e1701-e1702. [PMID: 36400077 DOI: 10.1016/s2214-109x(22)00474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Karine Scheuermaier
- Brain Function Research Group, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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28
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Macleod D, Shanaube K, Skalland T, Limbada M, Mandla N, Bwalya J, Schaap A, Yang B, Donnell D, Piwowar-Manning E, Eshleman SH, Hoddinott G, Bond V, Moore A, Griffith S, Bock P, Ayles H, Fidler S, Hayes R, Floyd S. Viral suppression and self-reported ART adherence after 3 years of universal testing and treatment in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: a cross-sectional analysis. Lancet HIV 2022; 9:e751-e759. [PMID: 36332652 PMCID: PMC9646982 DOI: 10.1016/s2352-3018(22)00237-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 07/25/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2014, UNAIDS set the target that 90% of individuals on antiretroviral therapy (ART) be virally suppressed. Here, we use data from the HPTN 071 (PopART) trial to report whether the introduction of universal testing and treatment has affected viral suppression or treatment adherence among individuals who self-reported they were taking ART, and identify risk factors for these outcomes. METHODS This was a cross-sectional study nested within the randomly selected population cohort of the PopART trial. The trial took place in 21 communities in Zambia and South Africa. Analyses included 3570 HIV-positive participants who were seen at the second follow-up visit in 2016-17 and who self-reported that they were currently taking ART. Viral suppression was defined as HIV RNA of less than 400 copies per mL from a blood sample collected during the cohort visit, and ART adherence was measured using self-reporting (reported as no missed pills in last 7 days). Prevalences of these outcomes were compared across three trial arms using a two-stage approach suitable for clustered data. Each arm consisted of seven communities, with one arm receiving a combination HIV prevention package including immediate ART initiation, one receiving a combination HIV prevention package excluding immediate ART initiation and one arm receving standard of care. Risk factors for each of the outcomes were assessed using logistic regression. FINDINGS Among the 3570 participants who self-reported that they were currently on ART, 416 (11·7%) of 3554 were not virally suppressed (16 were missing viral suppression status) and 345 (9·7%) of 3566 reported being non-adherent to ART (four were missing adherence status). The proportion not virally suppressed was higher in communities in South Africa (195 [16·4%] of 1191) than in Zambia (221 [9·4%] of 2363). There was no evidence that the prevalence of the outcomes differed between trial arms. There was evidence that men, younger individuals, individuals who reported participating in harmful alcohol use, and those who reported internalised stigma were more likely to be non-adherent, and not virally suppressed. INTERPRETATION The results assuaged concerns that early ART initiation in a universal testing and treatment setting could lead to reduced adherence and viral suppression. FUNDING US National Institute of Allergy and Infectious Diseases (which is a part of the National Institutes of Health), the International Initiative for Impact Evaluation with support from the Bill & Melinda Gates Foundation, US President's Emergency Plan for AIDS Relief, and Medical Research Council UK.
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Affiliation(s)
- David Macleod
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Mohammed Limbada
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nomtha Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Justin Bwalya
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ab Schaap
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Blia Yang
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Deborah Donnell
- HPTN Statistical and Data Management Centre, Seattle, WA, USA
| | | | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Virginia Bond
- Global Health and Development Department, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ayana Moore
- FHI 360, HIV Prevention Trials Network, Durham, NC, USA
| | - Sam Griffith
- FHI 360, HIV Prevention Trials Network, Durham, NC, USA
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Richard Hayes
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sian Floyd
- International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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29
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Chipanta D, Amo-Agyei S, Giovenco D, Estill J, Keiser O. Socioeconomic inequalities in the 90-90-90 target, among people living with HIV in 12 sub-Saharan African countries - Implications for achieving the 95-95-95 target - Analysis of population-based surveys. EClinicalMedicine 2022; 53:101652. [PMID: 36159044 PMCID: PMC9489496 DOI: 10.1016/j.eclinm.2022.101652] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inequalities undermine efforts to end AIDS by 2030. We examined socioeconomic inequalities in the 90-90-90 target among people living with HIV (PLHIV) -men (MLHIV), women (WLHIV) and adolescents (ALHIV). METHODS We analysed the available Population HIV Impact Assessment (PHIA) survey data for each of the 12 sub-Saharan African countries, collected between 2015 and 2018 to estimate the attainment of each step of the 90-90-90 target by wealth quintiles. We constructed concentration curves, computed concentration indices (CIX) -a negative (positive) CIX indicated pro-poor (pro-rich) inequalities- and identified factors associated with, and contributing to inequality. FINDINGS Socioeconomic inequalities in achieving the 90-90-90 target components among PLHIV were noted in 11 of the 12 countries surveyed: not in Rwanda. Awareness of HIV positive status was pro-rich in 5/12 countries (Côte d'Ivoire, Tanzania, Uganda, Malawi, and Zambia) ranging from CIX=0·085 (p< 0·05) in Tanzania for PLHIV, to CIX = 0·378 (p<0·1) in Côte d'Ivoire for ALHIV. It was pro-poor in 5/12 countries (Côte d'Ivoire, Ethiopia, Malawi, Namibia and Eswatini), ranging from CIX = -0·076 (p<0·05) for PLHIV in Eswatini, and CIX = -0·192 (p<0·05) for WLHIV in Ethiopia. Inequalities in accessing ART were pro-rich in 5/12 countries (Cameroun, Tanzania, Uganda, Malawi and Zambia) ranging from CIX=0·101 (p<0·05) among PLHIV in Zambia to CIX=0·774 (p<0·1) among ALHIV in Cameroun and pro-poor in 4/12 countries (Tanzania, Zimbabwe, Lesotho and Eswatini), ranging from CIX = -0·072 (p<0·1) among PLHIV in Zimbabwe to CIX = -0·203 (p<0·05) among WLHIV in Tanzania. Inequalities in HIV viral load suppression were pro-rich in 3/12 countries (Ethiopia, Uganda, and Lesotho), ranging from CIX = 0·089 (p< 0·1) among PLHIV in Uganda to CIX = 0·275 (p<0·01) among WLHIV in Ethiopia. Three countries (Tanzania CIX = 0·069 (p< 0·5), Uganda CIX = 0·077 (p< 0·1), and Zambia CIX = 0·116 (p< 0·1)) reported pro-rich and three countries (Côte d'Ivoire CIX = -0·125 (p< 0·1), Namibia CIX = -0·076 (p< 0·05), and Eswatini CIX = -0·050 (p< 0·05) pro-poor inequalities for the cumulative CIX for HIV viral load suppression. The decomposition analysis showed that age, rural-urban residence, education, and wealth were associated with and contributed the most to inequalities observed in achieving the 90-90-90 target. INTERPRETATION Some PLHIV in 11 of 12 countries were not receiving life-saving HIV testing, treatment, or achieving HIV viral load suppression due to socioeconomic inequalities. Socioeconomic factors were associated with and explained the inequalities observed in the 90-90-90 target among PLHIV. Governments should scale up equitable 95-95-95 target interventions, prioritizing the reduction of age, rural-urban, education and wealth-related inequalities. Research is needed to understand interventions to reduce socioeconomic inequities in achieving the 95-95-95 target. FUNDING This study was supported by the Swiss National Science Foundation (grant 202660).
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Affiliation(s)
- David Chipanta
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- United nations joint programme on HIV/AIDS (UNAIDS), Equality and Rights for All, Geneva 27, CH1211, Switzerland
- Corresponding author at: Institute of Global Health - University of Geneva, Campus Biotech, Chemin des mines 9, 1202 Genève – CH, Switzerland.
| | - Silas Amo-Agyei
- Department of Economics, University of Lausanne, Lausanne, Switzerland
| | - Danielle Giovenco
- Brown University, School of Public Health, International Health Institute, Providence, RI, USA
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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30
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Indravudh PP, Terris-Prestholt F, Neuman M, Kumwenda MK, Chilongosi R, Johnson CC, Hatzold K, Corbett EL, Fielding K. Understanding mechanisms of impact from community-led delivery of HIV self-testing: Mediation analysis of a cluster-randomised trial in Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001129. [PMID: 36962622 PMCID: PMC10021599 DOI: 10.1371/journal.pgph.0001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022]
Abstract
Community HIV strategies are important for early diagnosis and treatment, with new self-care technologies expanding the types of services that can be led by communities. We evaluated mechanisms underlying the impact of community-led delivery of HIV self-testing (HIVST) using mediation analysis. We conducted a cluster-randomised trial allocating 30 group village heads and their catchment areas to the community-led HIVST intervention in addition to the standard of care (SOC) or the SOC alone. The intervention used participatory approaches to engage established community health groups to lead the design and implementation of HIVST campaigns. Potential mediators (individual perceptions of social cohesion, shared HIV concern, critical consciousness, community HIV stigma) and the outcome (HIV testing in the last 3 months) were measured through a post-intervention survey. Analysis used regression-based models to test (i) intervention-mediator effects, (ii) mediator-outcome effects, and (iii) direct and indirect effects. The survey included 972 and 924 participants in the community-led HIVST and SOC clusters, respectively. The community-led HIVST intervention increased uptake of recent HIV testing, with no evidence of indirect effects from changes in hypothesised mediators. However, standardised scores for community cohesion (adjusted mean difference [MD] 0.15, 95% CI -0.03 to 0.32, p = 0.10) and shared concern for HIV (adjusted MD 0.13, 95% CI -0.02 to 0.29, p = 0.09) were slightly higher in the community-led HIVST arm than the SOC arm. Social cohesion, community concern, and critical consciousness also apparently had a quadratic association with recent testing in the community-led HIVST arm, with a positive relationship indicated at lower ranges of each score. We found no evidence of intervention effects on community HIV stigma and its association with recent testing. We conclude that the intervention effect mostly operated directly through community-driven service delivery of a novel HIV technology rather than through intermediate effects on perceived community mobilisation and HIV stigma.
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Affiliation(s)
- Pitchaya P. Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Moses K. Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Cheryl C. Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, United States of America
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Patel EU, Solomon SS, McFall AM, Prata Menezes N, Tomori C, Srikrishnan AK, Kumar MS, Celentano DD, Lucas GM, Mehta SH. Drug use stigma, antiretroviral therapy use, and HIV viral suppression in a community-based sample of people with HIV who inject drugs. AIDS 2022; 36:1583-1589. [PMID: 35730390 PMCID: PMC9391282 DOI: 10.1097/qad.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the association of drug use stigma with antiretroviral therapy (ART) use and HIV viral suppression among people with HIV who inject drugs in India. DESIGN Cross-sectional biobehavioral survey. METHODS Between August 2016 and May 2017, persons aged at least 18 years who reported injection drug use in the past 2 years were recruited via respondent-driven sampling (RDS) in 12 Indian cities (approximately 1000 per city). The analysis was restricted to participants with laboratory-confirmed HIV infection who self-reported a prior HIV diagnosis and were eligible for ART per concurrent national HIV treatment guidelines. Enacted and internalized drug use stigma were each measured by five to six-item subscales. The study outcomes were HIV viral suppression (<150 copies/ml) and self-reported past 30-day ART use. RDS-II weighted multivariable logistic regression with a city-level random-intercept was used to estimate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CIs). RESULTS Among 971 ART-eligible participants previously diagnosed with HIV, 65.1% reported ART use and 56.1% were virally suppressed. Reporting any enacted stigma (vs. none) was associated with lower odds of ART use [aOR = 0.26 (95% CI = 0.15-0.44)] and viral suppression [aOR = 0.49 (95% CI = 0.31-0.78)]. High internalized stigma scores (>median vs. ≤median) were associated with lower odds of viral suppression among participants aged at least 35 years [aOR = 0.51 (95% CI = 0.27-0.97)] but not among participants aged less than 35 years [aOR = 1.22 (95% CI = 0.57-2.60)]. Similar associations were observed in analyses restricted to participants ever linked to HIV care. CONCLUSION Drug use stigma may be a barrier to HIV viral suppression among people with HIV who inject drugs, thereby hindering efforts to achieve HIV control.
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Affiliation(s)
- Eshan U Patel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
| | - Allison M McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Neia Prata Menezes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Cecília Tomori
- Johns Hopkins University School of Nursing
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Vermund SH. Community mobilisation to achieve HIV testing and care goals. Lancet HIV 2022; 9:e597-e598. [PMID: 36055289 PMCID: PMC10773955 DOI: 10.1016/s2352-3018(22)00218-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/27/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Sten H Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA.
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Frescura L, Godfrey-Faussett P, Feizzadeh A. A, El-Sadr W, Syarif O, Ghys PD. Achieving the 95 95 95 targets for all: A pathway to ending AIDS. PLoS One 2022; 17:e0272405. [PMID: 35925943 PMCID: PMC9352102 DOI: 10.1371/journal.pone.0272405] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In December 2020, UNAIDS released a new set of ambitious targets calling for 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025. Adopted by United Nations Member states in June 2021 as part of the new Political Declaration on HIV and AIDS, these targets, combined with ambitious primary prevention targets and focused attention to supporting enablers, aim to bridge inequalities in treatment coverage and outcomes and accelerate HIV incidence reductions by focusing on progress in all sub-populations, age groups and geographic settings. Here we summarise the evidence and decisions underpinning the new global targets.
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Affiliation(s)
- Luisa Frescura
- Strategic Information Department, UNAIDS, Geneva, Switzerland
- * E-mail:
| | - Peter Godfrey-Faussett
- Strategic Information Department, UNAIDS, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Wafaa El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America
| | - Omar Syarif
- Global Network of People Network Living with HIV (GNP+), Gardens, South Africa
| | - Peter D. Ghys
- Strategic Information Department, UNAIDS, Geneva, Switzerland
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Pujol-Hodge E, Salazar-Gonzalez JF, Ssemwanga D, Charlebois ED, Ayieko J, Grant HE, Liegler T, Atkins KE, Kaleebu P, Kamya MR, Petersen M, Havlir DV, Leigh Brown AJ. Detection of HIV-1 Transmission Clusters from Dried Blood Spots within a Universal Test-and-Treat Trial in East Africa. Viruses 2022; 14:1673. [PMID: 36016295 PMCID: PMC9414799 DOI: 10.3390/v14081673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
The Sustainable East Africa Research in Community Health (SEARCH) trial was a universal test-and-treat (UTT) trial in rural Uganda and Kenya, aiming to lower regional HIV-1 incidence. Here, we quantify breakthrough HIV-1 transmissions occurring during the trial from population-based, dried blood spot samples. Between 2013 and 2017, we obtained 549 gag and 488 pol HIV-1 consensus sequences from 745 participants: 469 participants infected prior to trial commencement and 276 SEARCH-incident infections. Putative transmission clusters, with a 1.5% pairwise genetic distance threshold, were inferred from maximum likelihood phylogenies; clusters arising after the start of SEARCH were identified with Bayesian time-calibrated phylogenies. Our phylodynamic approach identified nine clusters arising after the SEARCH start date: eight pairs and one triplet, representing mostly opposite-gender linked (6/9), within-community transmissions (7/9). Two clusters contained individuals with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance, both linked to intervention communities. The identification of SEARCH-incident, within-community transmissions reveals the role of unsuppressed individuals in sustaining the epidemic in both arms of a UTT trial setting. The presence of transmitted NNRTI resistance, implying treatment failure to the efavirenz-based antiretroviral therapy (ART) used during SEARCH, highlights the need to improve delivery and adherence to up-to-date ART recommendations, to halt HIV-1 transmission.
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Affiliation(s)
- Emma Pujol-Hodge
- Ashworth Laboratories, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK; (E.P.-H.); (H.E.G.)
| | - Jesus F. Salazar-Gonzalez
- Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.F.S.-G.); (D.S.); (P.K.)
| | - Deogratius Ssemwanga
- Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.F.S.-G.); (D.S.); (P.K.)
- Uganda Virus Research Institute, Entebbe P.O. Box 49, Uganda
| | - Edwin D. Charlebois
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA 94158, USA;
| | - James Ayieko
- Kenya Medical Research Institute, Nairobi P.O. Box 54840-00200, Kenya;
| | - Heather E. Grant
- Ashworth Laboratories, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK; (E.P.-H.); (H.E.G.)
| | - Teri Liegler
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA 94110, USA; (T.L.); (D.V.H.)
| | - Katherine E. Atkins
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK;
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, LSHTM, London WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, LSHTM, London WC1E 7HT, UK
| | - Pontiano Kaleebu
- Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) and London School of Hygiene and Tropical Medicine (LSHTM) Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.F.S.-G.); (D.S.); (P.K.)
- Uganda Virus Research Institute, Entebbe P.O. Box 49, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Maya Petersen
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA 94110, USA; (T.L.); (D.V.H.)
| | - Andrew J. Leigh Brown
- Ashworth Laboratories, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3FL, UK; (E.P.-H.); (H.E.G.)
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Pedroso AO, Gomes D, Sousa SML, Ferreira GRON, Ramos AMPC, Polaro SHI, Nogueira LMV, Botelho EP. Temporal and Spatial Analysis Techniques as Potential Tools for Combating the HIV Epidemic among Young Brazilian Amazonian People: An Ecological Study. Trop Med Infect Dis 2022; 7:tropicalmed7070137. [PMID: 35878148 PMCID: PMC9319365 DOI: 10.3390/tropicalmed7070137] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The main goal of this study was to analyze the HIV epidemic temporally and spatially among young people living in Pará, Brazil, from 2007 to 2018. Methods: For the temporal analysis, we employed an integrated autoregression of moving averages model associated with the seasonal trend using the LOESS decomposition method, which allowed for predictions to be made. In the spatial analysis, the techniques of autocorrelation, spatial and spatio-temporal risk analysis, and geographically weighted regression were used. Results: During the study period, there were 8143 notifications of HIV/AIDS cases. The temporal prediction indicated a trend of growth in the incidence rate in the 20–24-year-old group from January 2019 to December 2022 and a trend of stability in the 15- to 19-year-old and 25- to 29-year-old groups. There was a territorial expansion of the HIV epidemic in Pará. Novo Progresso and the Metropolitan Region of Belém (RMB) were the zones with the highest spatial and spatio-temporal risk for HIV. Social determinants including the Basic Education Development Index, the number of physicians per 10,000 inhabitants, and the municipal high school abandonment rate in the municipalities were associated with the risk of HIV/AIDS among young people in Pará. Conclusions: To eliminate HIV among young people in Pará, the access to treatment, diagnosis, and preventive healthcare services should be expanded. Sexual and reproductive health education should be reinforced in schools and communities. Furthermore, it is necessary to promote social equity and fight HIV stigma.
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Affiliation(s)
- Andrey Oeiras Pedroso
- Programa de Pós-Graduação em Enfermagem, Federal University of Pará, Belém 66075-110, Brazil; (A.O.P.); (S.M.L.S.); (G.R.O.N.F.); (A.M.P.C.R.); (S.H.I.P.)
| | - Dulce Gomes
- Departamento de Matemática, Colégio Luís António Verney, University of Évora, 7000-671 Évora, Portugal;
| | - Sara Melissa Lago Sousa
- Programa de Pós-Graduação em Enfermagem, Federal University of Pará, Belém 66075-110, Brazil; (A.O.P.); (S.M.L.S.); (G.R.O.N.F.); (A.M.P.C.R.); (S.H.I.P.)
| | - Glenda Roberta Oliveira Naiff Ferreira
- Programa de Pós-Graduação em Enfermagem, Federal University of Pará, Belém 66075-110, Brazil; (A.O.P.); (S.M.L.S.); (G.R.O.N.F.); (A.M.P.C.R.); (S.H.I.P.)
| | - Aline Maria Pereira Cruz Ramos
- Programa de Pós-Graduação em Enfermagem, Federal University of Pará, Belém 66075-110, Brazil; (A.O.P.); (S.M.L.S.); (G.R.O.N.F.); (A.M.P.C.R.); (S.H.I.P.)
| | - Sandra Helena Isse Polaro
- Programa de Pós-Graduação em Enfermagem, Federal University of Pará, Belém 66075-110, Brazil; (A.O.P.); (S.M.L.S.); (G.R.O.N.F.); (A.M.P.C.R.); (S.H.I.P.)
| | | | - Eliã Pinheiro Botelho
- Programa de Pós-Graduação em Enfermagem, Federal University of Pará, Belém 66075-110, Brazil; (A.O.P.); (S.M.L.S.); (G.R.O.N.F.); (A.M.P.C.R.); (S.H.I.P.)
- Correspondence:
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Knight J, Kaul R, Mishra S. Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review. Epidemics 2022; 40:100608. [PMID: 35843152 DOI: 10.1016/j.epidem.2022.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Transmission models provide complementary evidence to clinical trials about the potential population-level incidence reduction attributable to ART (ART prevention impact). Different modelling assumptions about risk heterogeneity may influence projected ART prevention impacts. We sought to review representations of risk heterogeneity in compartmental HIV transmission models applied to project ART prevention impacts in Sub-Saharan Africa. METHODS We systematically reviewed studies published before January 2020 that used non-linear compartmental models of sexual HIV transmission to simulate ART prevention impacts in Sub-Saharan Africa. We summarized data on model structure/assumptions (factors) related to risk and intervention heterogeneity, and explored multivariate ecological associations of ART prevention impacts with modelled factors. RESULTS Of 1384 search hits, 94 studies were included. 64 studies considered sexual activity stratification and 39 modelled at least one key population. 21 studies modelled faster/slower ART cascade transitions (HIV diagnosis, ART initiation, or cessation) by risk group, including 8 with faster and 4 with slower cascade transitions among key populations versus the wider population. In ecological analysis of 125 scenarios from 40 studies (subset without combination intervention), scenarios with risk heterogeneity that included turnover of higher risk groups were associated with smaller ART prevention benefits. Modelled differences in ART cascade across risk groups also influenced the projected ART benefits, including: ART prioritized to key populations was associated with larger ART prevention benefits. Of note, zero of these 125 scenarios considered lower ART coverage among key populations. CONCLUSION Among compartmental transmission models applied to project ART prevention impacts in Sub-Saharan Africa, representations of risk heterogeneity and projected impacts varied considerably. Inclusion/exclusion of risk heterogeneity with turnover, and intervention heterogeneity across risk groups could influence the projected impacts of ART scale-up. These findings highlight a need to capture risk heterogeneity with turnover and cascade heterogeneity when projecting ART prevention impacts.
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Affiliation(s)
- Jesse Knight
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Medical Science, University of Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada; Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Bousmah MAQ, Iwuji C, Okesola N, Orne-Gliemann J, Pillay D, Dabis F, Larmarange J, Boyer S. Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 treatment as prevention trial in South Africa. Soc Sci Med 2022; 305:115068. [PMID: 35665689 PMCID: PMC9214548 DOI: 10.1016/j.socscimed.2022.115068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/29/2022] [Accepted: 05/21/2022] [Indexed: 11/27/2022]
Abstract
Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012–2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality – measured as the proportion of HIV tests performed among all contacts eligible for an HIV test – on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale. We estimated the costs of repeated home-based HIV counselling and testing (HB-HCT). The mean cost per new HIV diagnosis, which increased over HB-HCT rounds, was $1694. However, the mean cost per appropriate referral to HIV care was $269. A 1% increase in the scale of HB-HCT reduced the average cost per contact by 0.27%. Expanding the population coverage of HB-HCT offers opportunities for cost savings.
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Affiliation(s)
- Marwân-Al-Qays Bousmah
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France; Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France.
| | - Collins Iwuji
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa; Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | - Joanna Orne-Gliemann
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Deenan Pillay
- Research Department of Infection and Population Health, University College London, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - François Dabis
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | | | - Sylvie Boyer
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Ng'ambi WF, Estill J, Jahn A, Orel E, Chimpandule T, Nyirenda R, Keiser O. Factors associated with HIV viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System. Trop Med Int Health 2022; 27:639-646. [PMID: 35622358 DOI: 10.1111/tmi.13782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the prevalence of HIV viral suppression and assess the factors associated with HIV viral suppression among persons receiving antiretroviral therapy (ART) in Malawi in 2021. METHODS Implementation study using routinely collected patient-level HIV RNA-PCR test result data extracted from the national Laboratory Management Information System (LIMS) database managed by the Department of HIV/AIDS in 2021. We calculated frequencies, proportions and odds ratios (OR) of HIV viral suppression with their associated 95% confidence intervals (95%CIs). We performed a random-effects logistic regression to determine the risk factors associated with HIV viral suppression among ART patients, controlling for the spatial autocorrelation between districts and adjusting for other variables. RESULTS We evaluated 515,797 adults and children receiving ART and having a viral load test in 2021. Of these, 92.8% had HIV viral suppression. ART patients living in urban areas had lower likelihood of HIV viral suppression than those living in rural areas (adjusted OR [aOR] = 0.95, 95%CI: 0.92-0.99, p = 0.01). There was an increasing trend in HIV viral suppression with increasing ART duration. Routine VL monitoring samples were 39% more likely to have suppressed VL values than confirmatory HIV VL monitoring samples (aOR = 1.39; 95%CI: 1.34-1.43, p < 0.001). CONCLUSION This is the first national analysis of Malawi HIV VL data from LIMS. Our findings show the need to particularly consider the urban residents, those below 20 years, males, those on ART for less than a year as well as those on specific ARV regimens in order to persistently suppress HIV VL and consequently achieve the goal of achieving HIV VL suppression by 2030.
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Affiliation(s)
- Wingston Felix Ng'ambi
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Health Economics and Policy Unit, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Andreas Jahn
- Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi
| | - Erol Orel
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Rose Nyirenda
- Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Mugenyi L, Nanfuka M, Byawaka J, Agaba C, Mijumbi A, Kagimu D, Mugisha K, Shabbar J, Etukoit M. Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: An interrupted time series analysis. PLoS One 2022; 17:e0268226. [PMID: 35580126 PMCID: PMC9113587 DOI: 10.1371/journal.pone.0268226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Few studies have analysed the effect of HIV universal test and treat (UTT) on retention and mortality among people living with HIV (PLHIV) in routine care. We examined six-month retention and mortality at 11 health facilities (HFs) run by a large NGO, The AIDS Support Organisation (TASO), before and after UTT.
Methods
We used a quasi-experimental study using patient data extracted from 11 TASO HFs. Two periods, one before UTT (2015–2016) and the other during UTT (2017–2018) were compared. The primary outcome was six-month retention defined as the proportion of PLHIV who were alive and in care at six months from enrolment. The secondary outcome was six-month mortality defined as the proportion of PLHIV who died within six months from enrolment. We performed an interrupted time series analysis using graphical aids to study trends in six-month retention and mortality and a segmented regression to evaluate the effect of UTT. We used a generalized linear mixed model (GLMM) and generalized estimating equations (GEE) to account for facility-level clustering.
Results
Of the 20,171 PLHIV registered between 2015 and 2018 and included in the analysis, 12,757 (63.2%) were enrolled during the UTT period. 5256/7414 (70.9%) of the pre-UTT period compared to 12239/12757 (95.9%) of the UTT were initiated on ART treatment with 6 months from enrolment. The median time from enrolment to initiating ART was 14 (interquartile range (IQR): 0–31) days for the pre-UTT compared to 0 (IQR: 0–0) days for the UTT period. The median age at enrolment was 32.5 years for the pre-UTT and 35.0 years for the UTT period. Overall, the six-month retention just after scale-up of UTT, increased by 9.2 percentage points (p = 0.002) from the baseline value of 82.6% (95% CI: 77.6%-87.5%) but it eventually decreased at a rate 1.0 percentage point (p = 0.014) for cohorts recruited each month after UTT. The baseline six-month mortality was 3.3% (95% CI: 2.4%-4.2%) and this decreased by 1.6 percentage points (p = 0.003) immediately after UTT. The six-month mortality continued decreasing at a rate of 0.1 percentage points (p = 0.002) for cohorts enrolled each month after UTT. Retention differed between some health facilities with Rukungiri HF having the highest and Soroti the lowest retention. Retention was slightly higher among males and younger people. Mortality was highest among people aged 50 years and more. The effect of UTT on retention and mortality was similar across sex and age groups.
Conclusion
Overall, UTT significantly led to an immediate increase in retention and decrease in mortality among PLHIV enrolled in HIV care from 11 HFs run by TASO in Uganda. However, retention (and mortality) significantly decreased for cohorts enrolled each month after UTT. Retention was highest in Rukungiri and lowest in Soroti HFs and slightly higher in males and younger people. Mortality was highest in older patients and lowest in adolescents. We recommend for innovative interventions to improve the overall retention particularly in facilities reporting low retention in order to achieve the UNAIDS 2030 target of 95-95-95.
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Affiliation(s)
- Levicatus Mugenyi
- The AIDS Support Organization, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine, Entebbe Unit, Entebbe, Uganda
- * E-mail:
| | | | | | | | | | | | | | - Jaffer Shabbar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ntombela NP, Kharsany ABM, Soogun A, Yende-Zuma N, Baxter C, Kohler HP, McKinnon LR. Viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa: a cross sectional study to assess progress towards UNAIDS indicators and Implications for HIV Epidemic Control. Reprod Health 2022; 19:116. [PMID: 35550580 PMCID: PMC9097174 DOI: 10.1186/s12978-022-01419-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND South Africa has made significant progress in scaling up antiretroviral therapy (ART) to achieve the aspirational goal of HIV epidemic control. The aim of this study was to determine the prevalence of HIV, assess progress towards each of the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicators and determine factors associated with achieving viral suppression among pregnant adolescents and women living with HIV in rural KwaZulu-Natal, South Africa. METHODS Pregnant adolescents and women, 12 years and older seeking antenatal care at six primary health care clinics were enrolled in a cross-sectional study. Following written informed consent, structured questionnaires were administered, and finger-prick blood samples were collected for HIV antibody testing and viral load measurement. Viral suppression was defined as HIV viral load of < 400 copies per mL. RESULTS Between Dec 2016 and March 2017, among the 546 enrolled participants, data for 545 were analysed. The overall HIV prevalence was 40.2% [95% Confidence Interval (CI) 36.1-44.3]. Age-stratified prevalence increased from 22.1% (95% CI, 15.9-30.0) in the 14-19 year age group to 63.9% (95% CI, 55.1-71.9) among women ≥ 30 years (Χ2 trend P < 0.0001). Of the HIV positive participants, 84.5% (95% CI, 79.0-88.8) knew their HIV positive status, 98.3% (95% CI 95.1-99.4) who knew their status were on ART, and of those on ART, 95.9% (95% CI 91.8-98.0) were virally suppressed. Among all HIV-positives 90.8% (95% CI, 86.3-94.0) had achieved viral suppression, whilst those in the 14-19 year age group were least likely to be virally suppressed at 82.8% (95% CI 65.5-92.4) compared to those in the older age groups. Married women compared to those unmarried were more likely to have achieved viral suppression (PRR) of 1.11 (95% CI 1.05-1.18), P < 0.001. CONCLUSIONS The proportion of HIV positive pregnant women achieving viral suppression was encouraging though far short of the target towards achieving epidemic control. Importantly, adolescent pregnant women were less likely to know their HIV status and to achieve viral suppression, underscoring the public health implications of sustained risk of HIV transmission. Thus, greater effort and strong social support are essential to improve HIV knowledge of status and care continuum towards the goal to achieving HIV epidemic control. To "fast-track" the response to achieve HIV epidemic control and end the AIDS epidemic, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set ambitious HIV testing and treatment targets for people living with HIV. Meeting these targets through scaling up testing for HIV, initiating and sustaining antiretroviral therapy (ART) to maintain viral suppression provides both therapeutic and preventive benefits with the potential to reduce HIV transmission. Viral suppression among pregnant adolescents and women living with HIV is crucial for the prevention of mother-to-child transmission of HIV including onward transmission to sexual partners. As a public health approach, in South Africa all pregnant women are offered routine HIV testing and immediate initiation of lifelong ART irrespective of CD4 cell count. It is, therefore, important to ascertain progress towards reaching the targets. The proportion of HIV positive pregnant adolescents and women achieving viral suppression was encouraging though far short of the target towards achieving epidemic control. Importantly, pregnant adolescents were less likely to know their HIV status and to achieve viral suppression, underscoring the public health implications of sustained risk of HIV transmission. Thus, greater effort and strong social support are essential to improve HIV knowledge of status and care continuum towards the goal to achieving HIV epidemic control.
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Affiliation(s)
- Nonzwakazi P Ntombela
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
| | - Ayesha B M Kharsany
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa.
- 2nd Floor, Doris Duke Medical Research Institute, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, CAPRISA, University of KwaZulu-Natal, Private Bag 7, Congella, 4013, Durban, South Africa.
| | - Adenike Soogun
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
| | - Cheryl Baxter
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
- Current Affiliation for Dr Cheryl Baxter, Centre for Epidemic Response and Innovation (CERI), School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Hans-Peter Kohler
- Population Studies Center, University of Pennsylvania, New York, USA
| | - Lyle R McKinnon
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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Martelli G, Van Duffel L, Kwezi EC, Cavallin F, Salehe IA, Torelli GF, Putoto G, Hermans S, Rinke de Wit TF, Pozniak A. Community- and facility-based HIV testing interventions in northern Tanzania: Midterm results of Test & Treat Project. PLoS One 2022; 17:e0266870. [PMID: 35413074 PMCID: PMC9004748 DOI: 10.1371/journal.pone.0266870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Test & Treat Project offers universal HIV testing and access to antiretroviral treatment in Northern Tanzania. The current cross-sectional study provides midterm results on HIV testing and counseling activities through community outreaches and facility-based services. A total 255,329 HIV tests were performed: 198,451 (77.7%) during testing campaigns in the villages, 12,592 (4.9%) during special events outreach and 44,286 (17.4%) in the health facilities. Females represented 53.8% (23,809) among those tested in the health facilities, while males were the majority in the community (54.4%, 114,835). Over one third of tests (n = 104,605, 41%) were performed among first-time testers. The overall HIV positivity rate was 1.2%, ranging from 0.7% in the community to 3.8% in the health facilities and decreased over time. Using a multivariable analysis, a positive test result was associated with age ≥ 50 years (PR 1.22, 95% CI 1.11 to 1.34), with female gender (PR 1.61, 95% CI 1.50 to 1.73), being tested in health facilities (PR 5.00, 95% CI 4.65 to 5.36) and for the first time (PR 1.86, 95% CI 1.73 to 2.00). The estimated proportion of PLHIV who knew their status of the project area increased by 28.6% (from 35.7% to 64.3%) and 11.1% (from 57.7% to 68.8%) in the project areas of Shinyanga and Simiyu regions respectively. Reaching the first UNAIDS 90 target by the end of this project seems possible. Future strategies should focus on improving PITC coverage, implementing more targeted testing modalities, together with current universal community-based approach.
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Affiliation(s)
| | | | | | | | | | | | | | - Sabine Hermans
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tobias F. Rinke de Wit
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton Pozniak
- HIV and Sexual Health Clinic, Chelsea and Westminster Hospital NHS Foundation Trust London, London, United Kingdom
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Osewe PL, Peters MA. Prioritizing Global Public Health Investments for COVID-19 Response in Real Time: Results from a Delphi Exercise. Health Secur 2022; 20:137-146. [PMID: 35420445 PMCID: PMC9081018 DOI: 10.1089/hs.2021.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In the first months of the COVID-19 pandemic, there was a lack of guidance on how to channel the unprecedented amount of health financing toward the pandemic response. We employed a multistep, interactive Delphi process to reach consensus on a “menu” of priority COVID-19 response interventions. In all, 27 health security experts—representing national governments, bilateral and multilateral organizations, academia, technical agencies, and nongovernmental organizations—participated in the exercise. The experts rated 11 technical investment areas and 37 interventions on a 5-point scale in terms of their importance to COVID-19 response. Initial findings were discussed at a virtual meeting where experts suggested modifications. A group of 19 experts then rated a revised list of 11 technical areas and 39 interventions. Consensus was defined as at least 80% of experts agreeing on the importance of a technical area or intervention; stability of scores across the rounds was identified using Wilcoxon matched-pairs and unpaired signed rank tests. Between the initial and final menu, 3 technical areas and 7 interventions were slightly modified, 3 interventions were added, and 1 intervention was removed. Consensus was reached on all 11 technical areas and 35 of the final 39 interventions, and between 34 and 37 interventions were stable across rounds depending on the test used. In this exercise, the health security experts agreed that COVID-19 response financing should prioritize interventions that enhance a country's capacity to test, trace, and treat high-risk populations. Simultaneously, supportive systems (eg, risk communication, community engagement, public health infrastructure, information systems, policy and coordination, workforce capacity, other social protections) should be developed to ensure that nonpharmaceutical and medical interventions can maximize the effectiveness of these systems.
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Affiliation(s)
- Patrick L Osewe
- Patrick L. Osewe, MD, MPH, is Chief of Health Sector Group, Asian Development Bank, Manila, Philippines
| | - Michael A Peters
- Michael A. Peters, MSPH, PhD, was a Consultant, Asian Development Bank, Manila, Philippines. He is now Associate Faculty, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Individual and healthcare supply-related HIV transmission factors in HIV-positive patients enrolled in the antiretroviral treatment access program in the Centre and Littoral regions in Cameroon (ANRS-12288 EVOLCam survey). PLoS One 2022; 17:e0266451. [PMID: 35385535 PMCID: PMC8985982 DOI: 10.1371/journal.pone.0266451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Despite great progress in antiretroviral treatment (ART) access in recent decades, HIV incidence remains high in sub-Saharan Africa. We investigated the role of individual and healthcare supply-related factors in HIV transmission risk in HIV-positive adults enrolled in 19 HIV services in the Centre and Littoral regions of Cameroon.
Methods
Factors associated with HIV transmission risk (defined as both unstable aviremia and inconsistent condom use with HIV-negative or unknown status partners) were identified using a multi-level logistic regression model. Besides socio-demographic and behavioral individual variables, the following four HIV-service profiles, identified using cluster analysis, were used in regression analyses as healthcare supply-related variables: 1) district services with large numbers of patients, almost all practicing task-shifting and not experiencing antiretroviral drugs (ARV) stock-outs (n = 4); 2) experienced and well-equipped national reference services, most practicing task-shifting and not experiencing ARV stock-outs (n = 5); 3) small district services with limited resources and activities, almost all experiencing ARV stock-outs (n = 6); 4) small district services with a wide range of activities and half not experiencing ARV stock-outs (n = 4).
Results
Of the 1372 patients (women 67%, median age [Interquartile]: 39 [33–44] years) reporting sexual activity in the previous 12 months, 39% [min-max across HIV services: 25%-63%] were at risk of transmitting HIV. The final model showed that being a woman (adjusted Odd Ratio [95% Confidence Interval], p-value: 2.13 [1.60–2.82], p<0.001), not having an economic activity (1.34 [1.05–1.72], p = 0.019), having at least two sexual partners (2.45 [1.83–3.29], p<0.001), reporting disease symptoms at HIV diagnosis (1.38 [1.08–1.75], p = 0.011), delayed ART initiation (1.32 [1.02–1.71], p = 0.034) and not being ART treated (2.28 [1.48–3.49], p<0.001) were all associated with HIV transmission risk. Conversely, longer time since HIV diagnosis was associated with a lower risk of transmitting HIV (0.96 [0.92–0.99] per one-year increase, p = 0.024). Patients followed in the third profile had a higher risk of transmitting HIV (1.71 [1.05–2.79], p = 0.031) than those in the first profile.
Conclusions
Healthcare supply constraints, including limited resources and ARV supply chain deficiency may impact HIV transmission risk. To reduce HIV incidence, HIV services need adequate resources to relieve healthcare supply-related barriers and provide suitable support activities throughout the continuum of care.
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Kapoor A, Mussa A, Diseko M, Mayondi G, Mabuta J, Mmalane M, Makhema J, Morroni C, Lockman S, Zash R, Shapiro R. Cross-sectional trends in HIV prevalence among pregnant women in Botswana: an opportunity for PrEP? J Int AIDS Soc 2022; 25:e25892. [PMID: 35324084 PMCID: PMC8944218 DOI: 10.1002/jia2.25892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Young women in sub‐Saharan Africa are at particularly high risk of HIV acquisition. Recent shifts towards “test and treat” strategies have potential to reduce transmission in this age group but have not been widely studied outside of clinical trials. Using data from nationwide surveillance among pregnant women in Botswana, where a “test and treat” program was implemented in 2016, we describe trends in HIV prevalence over time and highlight opportunities for targeted prevention. Methods The Tsepamo study abstracted data from obstetric records of all women delivering at eight government hospitals in Botswana between 2015 and 2019, accounting for 45% of all births in the country (n = 120,755). We used a stratified analysis to identify prevalence trends and evaluated decreases in HIV prevalence over time using the Cochrane–Armitage test for linear trend. A multivariable logistic regression analysis was also performed to identify factors associated with declines in HIV prevalence. Results Overall HIV prevalence was 24.1% among 120,755 women who delivered during the study period. Prevalence differed by site of delivery, ranging from 16.1% to 28.2%, and increased markedly with age. Lower educational attainment (adjusted odds ratio [aOR] = 3.28; 95% confidence interval [CI] 3.07–3.50) and being unmarried (aOR = 1.98; 95% CI 1.88–2.08) were associated with HIV infection. HIV prevalence was 10.0% with a first pregnancy, 21.0% with a second and 39.2% with a third or greater (aOR = 2.20; for any prior pregnancy; 95% CI 2.10–2.29). The same age‐adjusted trends were seen when data were limited to women aged 15–24, with a two‐ to three‐fold increase in HIV prevalence between a first and third pregnancy. Prevalence decreased linearly during the 5‐year study period from 25.8% to 22.7% (p <0.001). Among age‐specific strata, the greatest absolute decline occurred in those aged 35–39, with an 8.7% absolute decrease in HIV prevalence from 2015 to 2019. Minimal declines were seen in those 15–24, with a decrease of only 1.5% over the same period. Conclusions While overall trends in Botswana show HIV prevalence declining among pregnant women, prevalence among the youngest age group has remained stagnant. Preventative interventions utilizing pre‐exposure prophylaxis should be prioritized during the high‐risk period surrounding a woman's first pregnancy.
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Affiliation(s)
- Andrew Kapoor
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Modiegi Diseko
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Gloria Mayondi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Judith Mabuta
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Shahin Lockman
- Harvard Medical School, Boston, Massachusetts, USA.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rebecca Zash
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Roger Shapiro
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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45
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Woolf-King SE, Sheinfil AZ, Ramos J, Foley JD, Moskal D, Firkey M, Kellen D, Maisto SA. A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action. Health Psychol Rev 2022; 16:104-133. [PMID: 32757813 PMCID: PMC8972079 DOI: 10.1080/17437199.2020.1806722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Affiliation(s)
| | - Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - David Kellen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Hovhannisyan L, Coelho LE, Velasque L, De Boni RB, Clark J, Cardoso SW, Lake J, Veloso VG, Grinsztejn B, Luz PM. Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil. AIDS Behav 2022; 26:947-962. [PMID: 34564777 PMCID: PMC8898026 DOI: 10.1007/s10461-021-03450-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.
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Affiliation(s)
- Lyolya Hovhannisyan
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth) , Houston, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Aging with HIV: Increased Risk of HIV Comorbidities in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042359. [PMID: 35206544 PMCID: PMC8872228 DOI: 10.3390/ijerph19042359] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022]
Abstract
With improved access to antiretroviral treatment (ART), adults with HIV live longer to reach older age. The number of older adults living with HIV is increasing steadily, giving rise to a new population of interest in HIV research and for invigorated considerations in health service delivery and policy. We analysed the profile of comorbidities in older people (50 years and older) living with HIV in South Africa. We conducted a secondary analysis of all individuals over 15 years who tested HIV positive in the Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. We conducted multivariate logistic regression to determine the factors associated with having HIV comorbidity using Stata 15.0 software. We entered 3755 people living with HIV into the analysis, of whom 18.3% (n = 688) were 50 years or older. Older adults had four times greater odds (OR = 4.7 (3.1-7.0)) of having an HIV comorbidity compared to younger adults. Being female (OR = 1.6 (1.1-2.4)) and living in an urban area (OR = 2.6 (1.8-3.7)) increased the odds of HIV comorbidity. Older adults with HIV require comprehensive health care to deal with multimorbidity, to maximise the benefits gained by advances in HIV therapies.
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48
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Harooni MZ, Atarud AA, Ehsan E, Alokozai A, McFarland W, Mirzazadeh A. Gaps in the continuum of care among people living with HIV in Afghanistan. Int J STD AIDS 2021; 33:282-288. [PMID: 34907832 DOI: 10.1177/09564624211055299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Afghanistan adopted a "test and treat" strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. METHODS We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. RESULTS Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35-44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. CONCLUSION Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.
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Affiliation(s)
| | | | | | | | - Willi McFarland
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Bor J, Fischer C, Modi M, Richman B, Kinker C, King R, Calabrese SK, Mokhele I, Sineke T, Zuma T, Rosen S, Bärnighausen T, Mayer KH, Onoya D. Changing Knowledge and Attitudes Towards HIV Treatment-as-Prevention and "Undetectable = Untransmittable": A Systematic Review. AIDS Behav 2021; 25:4209-4224. [PMID: 34036459 PMCID: PMC8147591 DOI: 10.1007/s10461-021-03296-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
People on HIV treatment with undetectable virus cannot transmit HIV sexually (Undetectable = Untransmittable, U = U). However, the science of treatment-as-prevention (TasP) may not be widely understood by people with and without HIV who could benefit from this information. We systematically reviewed the global literature on knowledge and attitudes related to TasP and interventions providing TasP or U = U information. We included studies of providers, patients, and communities from all regions of the world, published 2008–2020. We screened 885 papers and abstracts and identified 72 for inclusion. Studies in high-income settings reported high awareness of TasP but gaps in knowledge about the likelihood of transmission with undetectable HIV. Greater knowledge was associated with more positive attitudes towards TasP. Extant literature shows low awareness of TasP in Africa where 2 in 3 people with HIV live. The emerging evidence on interventions delivering information on TasP suggests beneficial impacts on knowledge, stigma, HIV testing, and viral suppression. Review was pre-registered at PROSPERO: CRD42020153725
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Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA.
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa.
| | - Charlie Fischer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
| | - Mirva Modi
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
| | | | | | - Rachel King
- UCSF Institute for Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | | | - Idah Mokhele
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Tembeka Sineke
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02119, USA
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Kenneth H Mayer
- Fenway Health Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Wits Health Consortium, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, GP, South Africa
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De Sá Pinheiro A, Souza Lima S, Oliveira Naiff Ferreira GR, Rodrigues Feijão A, Rosendo da Silva RA, Gir E, Reis RK, Vieira Pereira FM, Hisako Takase Gonçalves L, Isse Polaro SH, Pereira Cruz Ramos AM, Pinheiro Botelho E. HIV epidemic in a province of the Brazilian Amazon region: Temporal trend analysis. J Public Health Res 2021; 11. [PMID: 34850619 PMCID: PMC9363914 DOI: 10.4081/jphr.2021.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Although considerable progress has been made over the last decades, human
immunodeficiency virus (HIV) incidence and acquired immunodeficiency
syndrome (AIDS) mortality rates have remarkably increased in the Brazilian
Amazon region. Here, we employed temporal analysis to determine the impact
of public policies on the HIV epidemic in the state of Pará, Brazil, which
has the second highest HIV incidence rate in the Amazon region. Design and methods This is an ecological study conducted in the state of Pará, employing
secondary data of HIV/AIDS cases notified to the Information System for
Notifiable Diseases, 2007– 2018. The following epidemiological variables
were collected: year of notification, municipality of residence, age, sex,
education, exposure category, and HIV/AIDS diagnostic criteria. The study
population was composed of 21,504 HIV/AIDS cases. The HIV/AIDS incidence
rates were analyzed employing the temporal trend analysis (TTA) followed by
the chi-square test and residue analysis to determine the association
between the epidemiological variables and time series periods. Results A total of 50% of the notifications were composed of AIDS cases. TTA
identified two periods in HIV/AIDS incidence, with stabilization of cases in
the first period (G1, 2007–2012) and an upward trend in the second period
(G2, 2012–2018). The most prevalent epidemiological characteristics in G2
(versus G1) were as follows: young people, brown skin
color, higher schooling, and homosexuals. Conclusions Public policy to control HIV infection in the Brazilian Amazon region has
been partially effective. HIV screening tests and treatment should be made
widely available to eradicate HIV infection in the Amazon region by
2030.
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Affiliation(s)
| | - Sandra Souza Lima
- Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém.
| | | | | | | | - Elucir Gir
- Graduate Program in Fundamental Nursing, University of Sao Paulo, Ribeirão Preto.
| | - Renata Karina Reis
- Graduate Program in Fundamental Nursing, University of Sao Paulo, Ribeirão Preto.
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