Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study

Abstract Background There are limited data on individual HIV viral load (VL) trajectories at the population-level following the introduction of universal test and treat (UTT) in sub-Saharan Africa. Methods HIV VLs were assessed among HIV-positive participants at three population-based surveys in four Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (two consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95%CIs of persistent viremia were estimated using multivariate Poisson regression. Results There were 1,346 HIV-positive participants (n=1,883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.7% to 13.3%. Younger age (15-29 vs. 40-49 years, adjRR=1.80 [95%CI=1.19-2.71]), male sex (adjRR=2.09 [95%CI=1.47-2.95]), never being married (vs. currently married; adjRR=1.88 [95%CI=1.34-2.62]), and recent migration to the community (vs. long-term resident; adjRR=1.91 [95%CI=1.34-2.73]) were factors associated with persistent viremia. Conclusions Despite increases in durable VL suppression during roll-out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.

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Understanding the health systems impacts of Universal Test and Treat in sub-Saharan Africa: The Shape UTT study

Global Public Health ◽

10.1080/17441692.2020.1861317 ◽

2020 ◽

pp. 1-6

Author(s):

Jenny Renju ◽

Janet Seeley ◽

Mosa Moshabela ◽

Alison Wringe

Keyword(s):

Health Systems ◽

Sub Saharan Africa ◽

Test And Treat ◽

Universal Test ◽

Universal Test And Treat ◽

Sub Saharan

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Antiretroviral therapy adherence among patients enrolled after the initiation of the Universal Test and Treat strategy in Dessie town: a cross-sectional study

International Journal of STD & AIDS ◽

10.1177/0956462420927205 ◽

2020 ◽

Vol 31 (9) ◽

pp. 886-893

Author(s):

Yitayish Damtie ◽

Fentaw Tadese

Keyword(s):

Antiretroviral Therapy ◽

Cross Sectional Study ◽

Poor Adherence ◽

Art Adherence ◽

Sectional Study ◽

Cross Sectional ◽

Test And Treat ◽

Universal Test ◽

Universal Test And Treat ◽

Morisky Scale

Poor adherence was the major challenge in providing treatment, care, and support for people living with HIV (PLHIV). Evidence of adherence to antiretroviral therapy (ART) after initiation of the Universal Test and Treat (UTT) strategy was limited in Ethiopia. So, this study aimed to determine the proportion of ART adherence after the initiation of UTT strategy and associated factors among adult PLHIV in Dessie town using two adherence measurements. A cross-sectional study was conducted on 293 PLHIV selected using a systematic sampling technique. The data were collected by face-to face-interview using a pretested questionnaire; chart review was also used to collect the data. The proportion of ART adherence measured by using the Morisky scale and seven-day recall was 49.3% (95% CI: [43.5%, 54.8%]) and 95.9% (95% CI: [93.2%, 98.2%]), respectively. Being urban in residence (AOR = 3.72, 95% CI: [1.80, 7.68]), the absence of depression (adjusted odds ratio [AOR] = 3.72, 95% CI: [1.22, 11.35]), taking one tablet per day (AOR = 3.26, 95% CI: [1.64, 6.49]), and the absence of concomitant illness (AOR = 0.23, 95% CI: [0.09, 0.59]) were factors associated with ART adherence. The proportion of ART adherence measured by the Morisky scale was very low; however, adherence measured by seven-day recall was higher and consistent with World Health Organization recommendations. Residence, depression, and the number of tablets taken per day had a positive association with good ART adherence whereas having concomitant illness had a negative association with good ART adherence. Efforts should be made to improve adherence and interventions should be given to overcome factors linked with poor adherence.

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Deep–sequence phylogenetics to quantify patterns of HIV transmission in the context of a universal testing and treatment trial — BCPP/ Ya Tsie trial

10.1101/2021.06.19.21259186 ◽

2021 ◽

Author(s):

Lerato E Magosi ◽

Yinfeng Zhang ◽

Tanya Golubchick ◽

Victor De Gruttola ◽

Eric J Tchetgen Tchetgen ◽

...

Keyword(s):

Hiv Transmission ◽

Population Level ◽

Treatment As Prevention ◽

Population Mobility ◽

Mobility Patterns ◽

Test And Treat ◽

Hiv Intervention ◽

Universal Test ◽

Universal Test And Treat ◽

The Impact

Mathematical models predict that community–wide access to HIV testing–and–treatment can rapidly and substantially reduce new HIV infections. Yet several large universal test–and–treat HIV prevention trials in high–prevalence epidemics demonstrated variable reduction in population–level incidence. To elucidate patterns of HIV spread in universal test–and–treat trials we quantified the contribution of geographic–location, gender, age and randomized–HIV–intervention to HIV transmissions in the 30–community Ya Tsie trial in Botswana (estimated trial population: 175,664). Deep–sequence phylogenetic analysis revealed that most inferred HIV transmissions within the trial occurred within the same or between neighboring communities, and between similarly–aged partners. Transmissions into intervention communities from control communities were more common than the reverse post–baseline (30% [12.2 – 56.7] versus 3% [0.1 – 27.3]) than at baseline (7% [1.5 – 25.3] versus 5% [0.9 – 22.9]) compatible with a benefit from treatment–as–prevention. Our findings suggest that population mobility patterns are fundamental to HIV transmission dynamics and to the impact of HIV control strategies.

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