scholarly journals Mixed-method estimation of population-level HIV viral suppression rate in the Western Cape, South Africa

2020 ◽  
Vol 5 (8) ◽  
pp. e002522
Author(s):  
Elton Mukonda ◽  
Nei-Yuan Hsiao ◽  
Lara Vojnov ◽  
Landon Myer ◽  
Maia Lesosky
Keyword(s):  
Viral Suppression ◽  
Routine Data ◽  
Population Level ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
People Living With Hiv ◽  
Western Cape ◽  
Test Results ◽  
Individual Level

IntroductionThere are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from antiretroviral therapy (ART) programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates.MethodsVL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test-level and individual-level VS rates were based on test VL values <1000 cps/mL, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived midyear population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data.ResultsApproximately 1.9 million VL test results between 2008 and 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed VL testing coverage and population HIV prevalence.ConclusionWhile validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.

scholarly journals Mixed method estimation of population level HIV viral suppression rate in the Western Cape, South Africa

2020 ◽  
Author(s):  
Elton Mukonda ◽  
Nei-Yuan Hsiao ◽  
Lara Vojnov ◽  
Landon Myer ◽  
Maia Lesosky
Keyword(s):  
Viral Suppression ◽  
Routine Data ◽  
Population Level ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
People Living With Hiv ◽  
Western Cape ◽  
Test Results ◽  
Individual Level

AbstractIntroductionThere are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from ART programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates.MethodsVL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test- and individual-level VS rates were based on test VL values <1000 cps/ml, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived mid-year population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data.ResultsApproximately 1.9 million VL test results between 2008 – 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed ART coverage and population HIV prevalence.ConclusionWhile validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.

scholarly journals Evaluation of multi-assay algorithms for identifying individuals with recent HIV infection: HPTN 071 (PopART)

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0258644
Author(s):  
Wendy Grant-McAuley ◽  
Ethan Klock ◽  
Oliver Laeyendecker ◽  
Estelle Piwowar-Manning ◽  
Ethan Wilson ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Point Of Care ◽  
Population Level ◽  
Hiv Viral Load ◽  
Cross Sectional ◽  
Individual Level ◽  
Viral Loads ◽  
Incidence Estimation ◽  
Duration Of Infection ◽  
Recent Hiv Infection

Background Assays and multi-assay algorithms (MAAs) have been developed for population-level cross-sectional HIV incidence estimation. These algorithms use a combination of serologic and/or non-serologic biomarkers to assess the duration of infection. We evaluated the performance of four MAAs for individual-level recency assessments. Methods Samples were obtained from 220 seroconverters (infected <1 year) and 4,396 non-seroconverters (infected >1 year) enrolled in an HIV prevention trial (HPTN 071 [PopART]); 28.6% of the seroconverters and 73.4% of the non-seroconverters had HIV viral loads ≤400 copies/mL. Samples were tested with two laboratory-based assays (LAg-Avidity, JHU BioRad-Avidity) and a point-of-care assay (rapid LAg). The four MAAs included different combinations of these assays and HIV viral load. Seroconverters on antiretroviral treatment (ART) were identified using a qualitative multi-drug assay. Results The MAAs identified between 54 and 100 (25% to 46%) of the seroconverters as recently-infected. The false recent rate of the MAAs for infections >2 years duration ranged from 0.2%-1.3%. The MAAs classified different overlapping groups of individuals as recent vs. non-recent. Only 32 (15%) of the 220 seroconverters were classified as recent by all four MAAs. Viral suppression impacted the performance of the two LAg-based assays. LAg-Avidity assay values were also lower for seroconverters who were virally suppressed on ART compared to those with natural viral suppression. Conclusions The four MAAs evaluated varied in sensitivity and specificity for identifying persons infected <1 year as recently infected and classified different groups of seroconverters as recently infected. Sensitivity was low for all four MAAs. These performance issues should be considered if these methods are used for individual-level recency assessments.

scholarly journals How education mitigates the realisation of fertility intentions: Is sub-Saharan Africa different?

2018 ◽  
Author(s):  
Melanie Channon ◽  
SARAH HARPER
Keyword(s):  
Educational Achievement ◽  
Fertility Transition ◽  
Population Level ◽  
Fertility Intentions ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Individual Level ◽  
Highly Educated ◽  
Sub Saharan ◽  
The Individual

The gap between achieved fertility and fertility ideals is notably higher in sub-Saharan Africa (SSA) than elsewhere, relating to both under- and overachievement of fertility ideals. We consider the extent to which the relationship between fertility ideals and achieved fertility is mitigated by educational achievement. Further, we consider if the effect of education acts differently in SSA, and thereby hypothesise how increasing levels of education in SSA may decrease fertility.We use 227 Demographic and Health Surveys from 57 countries worldwide to look at population- and individual-level measures of achieving fertility ideals. Population level measures are used to assess whether the correspondence between fertility intentions and achievements differ by level of education. We then look at the individual-level determinants of both under- and overachieving fertility intentions. An average of 40% of women in SSA underachieve their stated fertility intentions compared to 26% in non-SSA countries. Furthermore, the educational gradient of underachievement is different in SSA where higher levels of education are not related to better correspondence between fertility intentions and achievements. We argue that the phenomenon of underachieving fertility ideals (or unrealized fertility) may be of particular importance for the ongoing fertility transition throughout SSA, especially for highly educated groups.

scholarly journals Increasing Longevity and the New Demography of Death

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
George W. Leeson
Keyword(s):  
20Th Century ◽  
21St Century ◽  
Population Level ◽  
Sub Saharan Africa ◽  
Global Level ◽  
England And Wales ◽  
Individual Level ◽  
Life Expectancy At Birth ◽  
Sub Saharan ◽  
Using Data

The world is ageing at both an individual and population levels and population ageing is truly a global phenomenon, the only notable region of exception being sub-Saharan Africa, which remains relatively young in demographic terms. At an individual level, life expectancies at birth have increased at the global level from 47 years in the mid-20th century to around 70 years today and are expected to rise to 76 years by the mid-21st century. At the population level, the proportion of the world’s population aged 60 years and over has increased from 8 percent in the mid-20th century to 12 percent, and by 2050, it is expected to reach 21 percent. In Europe, ageing has continued at a slower rate, but with the emergence of increasing numbers of centenarians. This paper outlines the transition using data from England and Wales from a demography of young death in the mid-19th century to a demography of survival in the 20th century and on to the new demography of old death in the 21st century. The paper provides evidence that it is likely that ages at death will continue to increase, with more and more people reaching extreme old age. At the same time, it is likely that life expectancies at birth will continue to rise, taking life expectancy at birth in England and Wales to 100 years or more by the end of the 21st century. The new 21st century demography of death will lead to annual numbers of deaths far in excess of previous maxima.

scholarly journals Predicting HIV Incidence in the SEARCH Trial: A Mathematical Modelling Study

2018 ◽  
Author(s):  
Britta L. Jewell ◽  
Anna Bershteyn
Keyword(s):  
Male Circumcision ◽  
Viral Suppression ◽  
Scale Up ◽  
Geographic Region ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Treatment As Prevention ◽  
Hiv Incidence ◽  
Search Trial ◽  
Using Data

ABSTRACTIntroductionSEARCH is one of four randomized-controlled trials (RCTs) investigating the strategy of community-based treatment-as-prevention (TasP) for the reduction of HIV incidence in sub-Saharan Africa. SEARCH takes place among 32 pair-matched rural communities in three regions of East Africa and exceeded the UNAIDS 90-90-90 targets for HIV testing, linkage to care, and viral suppression in the intervention arm. We used mathematical modeling to estimate expected 3-year cumulative HIV incidence in both arms of the trial, using different assumptions about two main sources of uncertainty: scale-up of antiretroviral therapy (ART) in the control arm, and the degree of mixing between SEARCH residents and non-residents.MethodsWe used the HIV modelling software EMOD-HIV to configure and calibrate a new model of the SEARCH communities. The 32 trial communities were clustered into six nodes (three for the control arm and three for the intervention arm) using k-means clustering based on community HIV prevalence, male circumcision rates, mobility, and geographic region. The model was parameterized using data on demographics, HIV prevalence, male circumcision rates, and viral suppression data collected at trial baseline in 2013, and calibrated to nodespecific and age-specific HIV prevalence, ART coverage, and population size. Using data on ART scale-up in subsequent follow-up years in the trial, we varied linkage to ART in the control arm and the degree of external mixing between SEARCH residents and non-residents.ResultsIf no external mixing and no additional control arm ART linkage occurred, we estimate the trial would report a relative risk (RR) of 0.60 (95% CI 0.54-0.67, p<0.001), with all simulations showing a significant result. However, if SEARCH residents mixed equivalently with non-residents and ART linkage in the control arm also increased such that the control arm also exceeded the 73% viral suppression target, the RR is estimated to be 0.96 (95% CI 0.87-1.06, p=0.458) and 72% of simulations are non-significant. Given our “best guess” assumptions about external mixing and year 3 data on ART linkage in the control arm, the RR is estimated to be 0.90 (95% CI 0.81-1.00, p=0.05), with 49% non-significant simulations.ConclusionThe SEARCH trial is predicted to show a 4-40% reduction in cumulative 3-year incidence, but between 18-72% of simulations were non-significant if either or both ART linkage in the control arm and external mixing are substantial. Despite achieving the 90-90-90 targets, our “best guess” is that the SEARCH trial has an equal probability of reporting a non-significant reduction in HIV incidence as it does a significant reduction.

scholarly journals Trends of HIV/AIDS Infection in Arsi Zone from 2002-2008 E.C (2010 to 2016 G.C), Oromia Region Ethiopia: Evidence from VCT Registry

2020 ◽  
Author(s):  
Mesfin Segni Tafa ◽  
Hailu Fekadu ◽  
Martha Aseffa ◽  
Hirpo Teno
Keyword(s):  
Logistic Regression ◽  
Hiv Prevalence ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Public Health Issue ◽  
P Value ◽  
People Living With Hiv ◽  
Global Public Health ◽  
Arsi Zone ◽  
Hiv Aids

Abstract Introduction: HIV continues to be a major global public health issue, having claimed more than 35 million lives so far. Globally, about 36.7 million people living with HIV currently, more than two third of the infection is the burden of Sub-Saharan Africa. Knowing the status of HIV/AIDS has the great value to individual health of treatment with ART and in terms of reductions in individual morbidity and mortality, and is equally cost-effective. Therefore, the aim of this study was to assess trends and associated factor of HIV infection in Arsi zone from 2010 to 2016.Methodology: A retrospective study was conducted in Arsi zone. Thirty health facilities (27 health centers and 3 Hospitals) were selected for the study from all woreda in the Zone. A total of 205,691 data was collected from VCT registration book. Data were entered into computer using Epi info 3.5.4 and exported for analysis to SPSS 21. Data were presented using tables and figures using line graphs. Logistic regression was used to see the association and significance was declared at P-value<0.05 Result: The study showed a total of 4300 HIV positive cases were reported between 2002(2009 G.C) to 2008(2016 G.C) according to available VCT registration book during survey at 30 health facilities. The trends of HIV of infection were not properly defined, it was 3.4% in 2002(2010 G.C ) and mean while a gradual drop has been observed in the next five consecutive years, almost which was less than 2% prevalence and in 2008 the prevalence was raised to 2.4% compared to 2007 and before. The changes in HIV prevalence were uneven among districts. Findings from logistic regression analysis indicated that the fitted demographic characteristics like, marital status, age and occupation were significantly associated with HIV positivity in both bivariate and multivariate analysis.Conclusion: There are no encouraging indications that the HIV prevalence has decreasing since there were variation among districts. Therefore there is a need of designing comprehensive strategy to combat the spread of HIV infections among all individuals. It is also important to strengthening VCT services at all level with strict follow up.

scholarly journals Source-sink dynamics could sustain HIV epidemics in rural communities in sub-Saharan Africa: the case of Malawi

2018 ◽  
Author(s):  
Justin T. Okano ◽  
Katie Sharp ◽  
Laurence Palk ◽  
Sally Blower
Keyword(s):  
Rural Communities ◽  
Geographic Variation ◽  
Rural Areas ◽  
Population Level ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Heterosexual Transmission ◽  
Urban Centers ◽  
Mobility Data ◽  
Sub Saharan

AbstractBackground:Approximately 25.5 million individuals are infected with HIV in sub-Saharan Africa (SSA). Epidemics in this region are generalized, show substantial geographic variation in prevalence, and are driven by heterosexual transmission; populations are highly mobile. We propose that generalized HIV epidemics should be viewed as a series of micro-epidemics occurring in multiple connected communities. Using a mathematical model, we test the hypothesis that travel can sustain HIV micro-epidemics in communities where transmission is too low to be self-sustaining. We use Malawi as a case study.Methods:We first conduct a mapping exercise to visualize geographic variation in HIV prevalence and population-level mobility. We construct maps by spatially interpolating georeferenced HIV-testing and mobility data from a nationally representative population-level survey: the 2015-16 Malawi Demographic and Health Survey. To test our hypothesis, we construct a novel HIV epidemic model that includes three transmission pathways: resident-to-resident, visitor-caused and travel-related. The model consists of communities functioning as “sources” and “sinks”. A community is a source if transmission is high enough to be self-sustaining, and a sink if it is not.Results:HIV prevalence ranges from zero to 27%. Mobility is high, 27% of the population took a trip lasting at least a month in the previous year. Prevalence is higher in urban centers than rural areas, but long-duration travel is higher in rural areas than urban centers. We show that a source-community can sustain a micro-epidemic in a sink-community, but only if specific epidemiological and demographic threshold conditions are met. The threshold depends upon the level of transmission in the source- and sink-communities, as well as the relative sizes of the two communities. The larger the source than the sink, the lower transmission in the source-community needs to be for sustainability.Discussion:Our results support our hypothesis, and suggest that it may be rather easy for large urban communities to sustain HIV micro-epidemics in small rural communities; this may be occurring in northern Malawi. Visitor-generated and travel-related transmission may also be sustaining micro-epidemics in rural communities in other SSA countries with highly-mobile populations. It is essential to consider mobility when developing HIV elimination strategies.

scholarly journals Preparing a Financial Incentive Program to Improve Adherence to ART for Scale: Using an Implementation Science Framework to Evaluate an mHealth System in Tanzania

2021 ◽  
Author(s):  
Laura Packel ◽  
Carolyn Fahey ◽  
Atuganile Kalinjila ◽  
Agatha Mnyippembe ◽  
Prosper Njau ◽  
...  
Keyword(s):  
Implementation Science ◽  
Financial Incentives ◽  
Viral Suppression ◽  
Cash Transfers ◽  
Sub Saharan Africa ◽  
Biometric Identification ◽  
People Living With Hiv ◽  
Main Trial ◽  
Mobile Money ◽  
Mobile Payments

Abstract Background: Viral suppression is key to ending the HIV epidemic, yet only 58% of people living with HIV (PLHIV) in sub-Saharan Africa are suppressed. Cash transfers are an effective strategy to improve adherence, but little is known about optimization of implementation; for example, designing effective programs that integrate into existing clinic workflows. We studied implementation of an mHealth system to deliver cash transfers to support antiretroviral medication (ART) adherence.Methods: We conducted an “implementation science-effectiveness” randomized controlled trial evaluating cash transfers conditional on visit attendance for viral suppression among Tanzanian PLHIV initiating ART. An mHealth system using fingerprint identification and mobile payments was used to automatically disburse mobile money to eligible PLHIV. We used Proctor’s framework, assessing implementation of the mHealth system from the perspectives of PLHIV and clinicians. We analyzed mHealth system data and conducted surveys (n=530) and in-depth interviews (n=25) with PLHIV, clinic and pharmacy staff (n=10), and structured clinic observations (n=2,293 visits).Results: 1,651 cash transfers were delivered to 346 PLHIV in the cash arms, 78% through mobile money. Among those in the cash arms, 81% registered their mobile money account with the mHealth system by study end, signaling high adoption. While acceptability for fingerprinting and mobile payments was high among PLHIV, interviews revealed mixed views: some had privacy concerns while others felt the system was secure and accurate, and provided some legitimacy to the clinical visits. Pharmacists praised system efficiency, but concerns about duplicative recordkeeping and added work arose. Clinic staff voiced excitement for the system’s potential to bring the cash program to all patients and simplify workflows; yet concerns about multiple systems, staffing, and intermittent connectivity tempered enthusiasm, highlighting structural issues beyond program scope. Structured observations revealed a steep learning curve; repeat fingerprint scans and manual entry declined as the system improved. Conclusions: Biometric identification and mobile payments were acceptable to most patients and staff. Fingerprinting encountered some feasibility limitations in the first months of testing, however mobile payments were highly successful. Biometric identification and mobile payments may provide a scalable mechanism to improve patient tracking and efficiently implement financial incentives in low-resource settings.Trial RegistrationName of the registry: clinicaltrials.govTrial registration number: NCT03351556Date of registration: 11/24/2017URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03351556?term=mccoy&cntry=TZ&draw=2&rank=4Checklists: StaRI (included with submission). Note CONSORT for cluster randomized trials was used for the main trial but is not directly applicable to this manuscript.

Human immunodeficiency virus funding and access to treatment in sub-Saharan Africa

2021 ◽  
pp. 095646242110422
Author(s):  
Reuben Granich ◽  
Somya Gupta ◽  
Brian Williams
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Access To Treatment ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Funding

Human immunodeficiency virus (HIV) treatment prevents illness, death, and transmission. The 90-90-90 disease control target is only 73% of people living with HIV virally suppressed. For 2010 to 2019, we abstracted HIV funding data for 40 countries in sub-Saharan Africa (70% of global HIV burden and >99% of HIV burden in the region in 2018). During 2010–2019, there was ∼$52 billion funding for 40 countries (99% Africa HIV burden). Domestic funding ranged from $0 to $3.2 billion. PEPFAR funding was $32 billion (average $1.4 billion; range $0.089–4.3 billion) among 22 countries. Global Fund averaged $306 million ($1.9 million to $1.1 billion) for 40 countries. Among PLHIV, known HIV status averaged 80% (11% to 94%). ART coverage averaged 64% (9% to 90%). Viral suppression among PLHIV ranged from 8% to 87%. Of the 40 countries, 21 reported under 60% of PLHIV to be on treatment and 13 did not report viral suppression for 2018. Achieving 90-90-90 is feasible in challenging settings if resources are used efficiently. Despite the significant investment in the HIV response, many countries have not reached the 90-90-90 target. Greater attention to efficiency and prioritizing important targets will be required to end AIDS in Africa.

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