scholarly journals HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260892
Author(s):  
Rejoice Nkambule ◽  
Neena M. Philip ◽  
Giles Reid ◽  
Zandile Mnisi ◽  
Harriet Nuwagaba-Biribonwoha ◽  
...  
Keyword(s):  
Viral Load ◽  
Population Based ◽  
Hiv Prevalence ◽  
Relative Reduction ◽  
Hiv Incidence ◽  
Viral Load Suppression ◽  
Hiv Rna ◽  
National Response ◽  
The Impact ◽  
Log Ratio

With the highest HIV incidence and prevalence globally, the government of Eswatini started a substantial scale-up of HIV treatment and prevention services in 2011. Two sequential large population-based surveys were conducted before and after service expansion to assess the impact of the national response. Cross-sectional, household-based, nationally representative samples of adults, ages 18 to 49 years, were sampled in 2011 and 2016. We measured HIV prevalence, incidence (recent infection based on limiting antigen ≤1.5 optical density units and HIV RNA ≥1000 copies/mL), viral load suppression (HIV RNA <1000 copies/mL among all seropositive adults) and unsuppressed viremia (HIV RNA ≥1000 copies/mL among all, regardless of HIV status) and assessed for temporal changes by conducting a trend analysis of the log ratio of proportions, using a Z statistic distribution. HIV prevalence remained stable from 2011 to 2016 [32% versus 30%, p = 0.10]. HIV incidence significantly declined 48% [2.48% versus 1.30%, p = 0.01]. Incidence remained higher among women than men [2011: 3.16% versus 1.83%; 2016: 1.76% versus 0.86%], with a smaller but significant relative reduction among women [44%; p = 0.04] than men [53%; p = 0.09]. The proportion of seropositive adults with viral load suppression significantly increased from 35% to 71% [p < .001]. The proportion of the total adult population with unsuppressed viremia decreased from 21% to 9% [p < .001]. National HIV incidence in Eswatini decreased by nearly half and viral load suppression doubled over a five-year period. Unsuppressed viremia in the total population decreased 58%. These population-based findings demonstrate the national impact of expanded HIV services in a hyperendemic country.

scholarly journals What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248410
Author(s):  
Nolwenn Conan ◽  
Cyrus P. Paye ◽  
Reinaldo Ortuno ◽  
Alexander Chijuwa ◽  
Brown Chiwandira ◽  
...  
Keyword(s):  
Young Adults ◽  
Viral Load ◽  
Health Facility ◽  
Population Based ◽  
Hiv Care ◽  
Hiv Positive ◽  
Viral Load Suppression ◽  
Hiv Rna ◽  
Hiv Test ◽  
Cascade Of Care

Introduction The Malawi Ministry of Health (MoH) has been in collaboration with Médecins sans Frontières (MSF) to increase access to quality HIV care through decentralization of antiretroviral therapy (ART) diagnosis and treatment from hospital to clinics in Nsanje District since 2011. A population-based household survey was implemented to provide information on HIV prevalence and cascade of care to inform and prioritize community-based HIV interventions in the district. Methods A cross-sectional survey was conducted between September 2016 and January 2017. Using two-stage cluster sampling, eligible adult individuals aged ≥15 years living in the selected households were asked to participate. Participants were interviewed and tested for HIV at home. Those tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their ART status. All participants tested HIV-positive at the time of the survey were advised to report their HIV test result to the health facility of their choice that MSF was supported in the district. HIV-RNA VL results were made available in this health facility. Results Among 5,315 eligible individuals, 91.1% were included in the survey and accepted an HIV test. The overall prevalence was 12.1% (95% Confidence Interval (CI): 11.2–13.0) and was higher in women than in men: 14.0% versus 9.5%, P<0.001. Overall HIV-positive status awareness was 80.0% (95%CI: 76.4–83.1) and was associated with sex (P<0.05). Linkage to care was 78.0% (95%CI: 74.3–81.2) and participants in care 76.2% (95%CI: 72.4–79.5). ART coverage among participants aware of their HIV-positive status was 95.3% (95%CI: 92.9–96.9) and was not associated with sex (P = 0.55). Viral load suppression among participants on ART was 89.9% (95%CI: 86.6–92.4) and was not statistically different by sex (p = 0.40). Conclusions Despite encouraging results in HIV testing coverage, cascade of care, and UNAIDS targets in Nsanje District, some gap remains in the first 90, specifically among men and young adults. Enhanced community engagement and new strategies of testing, such as index testing, could be implemented to identify those who are still undiagnosed, particularly men and young adults.

scholarly journals Migration in Namibia and its association with HIV acquisition and treatment outcomes

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256865
Author(s):  
Andrea Low ◽  
Karam Sachathep ◽  
George Rutherford ◽  
Anne-Marie Nitschke ◽  
Adam Wolkon ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Population Level ◽  
Population Based ◽  
Hiv Prevalence ◽  
Self Report ◽  
Viral Load Suppression ◽  
Recent Infection ◽  
Effective Prevention ◽  
Hiv Test

Background In the 21st century, understanding how population migration impacts human health is critical. Namibia has high migration rates and HIV prevalence, but little is known about how these intersect. We examined the association between migration and HIV-related outcomes using data from the 2017 Namibia Population-based HIV Impact Assessment (NAMPHIA). Methods and findings The NAMPHIA survey selected a nationally representative sample of adults in 2017. All adults aged 15–64 years were invited to complete an interview and home-based HIV test. Recent infection (<130 days) was measured using HIV-1 LAg avidity combined with viral load (>1000 copies/mL) and antiretroviral analyte data. Awareness of HIV status and antiretroviral use were based on self-report and/or detectable antiretrovirals in blood. Viremia was defined as having a viral load ≥1000 copies/mL, including all participants in the denominator regardless of serostatus. We generated community viremia values as a weighted proportion at the EA level, excluding those classified as recently infected. Significant migrants were those who had lived outside their current region or away from home >one month in the past three years. Recent cross-community in-migrants were those who had moved to the community <two years ago. Separate analyses were done to compare significant migrants to non-migrants and recent cross-community in-migrants to those who in-migrated >two years ago to determine the association of migration and timing with recent infection or viral load suppression (VLS). All proportions are weighted. Of eligible adults, we had HIV results and migration data on 9,625 (83.9%) of 11,474 women and 7,291 (73.0%) of 9,990 men. Most respondents (62.5%) reported significant migration. Of cross-community in-migrants, 15.3% were recent. HIV prevalence was 12.6% and did not differ by migration status. Population VLS was 77.4%. Recent cross-community in-migration was associated with recent HIV infection (aOR: 4.01, 95% CI 0.99–16.22) after adjusting for community viremia. Significant migration (aOR 0.73, 95% CI: 0.55–0.97) and recent cross-community in-migration (aOR 0.57, 95% CI: 0.35–0.92) were associated with lower VLS, primarily due to lack of awareness of HIV infection. The study was limited by lack of precise data on trajectory of migration. Conclusions Despite a high population-level VLS, Namibia still has migrant populations that are not accessing effective treatment for HIV. Targeting migrants with effective prevention and testing programs in communities with viremia could enable further epidemic control.

scholarly journals Factors Associated with Men Engagement in HIV Continuum of Care in Rwanda: A Cross Sectional Study to Identify Gaps to be Closed Towards HIV Epidemic Control in Rwanda

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Rwibasira GN ◽  
◽  
Rutayisire E ◽  
Keyword(s):  
Viral Load ◽  
Population Based ◽  
Cross Sectional Study ◽  
Viral Load Suppression ◽  
Cross Sectional ◽  
Hiv Services ◽  
Services Delivery ◽  
Hiv Epidemic ◽  
Hiv Continuum Of Care ◽  
The Impact

Despite the global achievements to control HIV epidemic and end AIDS by 2030, there is still a discrepancy in accessing HIV services. Men are among the population that are lagging behind when it comes to consuming available services to mitigate the impact of HIV/AIDS. We conducted this study to determine the level of Rwandan men engagement in HIV services delivery. We used cross- sectional design to analyze data from a Population- based HIV impact assessment, a household-based survey conducted in Rwanda from October 2018 to March 2019. Cascade from awareness of the HIV status, linkage to ART and Viral load suppression were analyzed. Logistic regression analysis was conducted to establish relationship between independent variables and outcomes. Data cleaning and analysis was conducted using SAS 9.4. 13. A total of 821 males aged 15 to 64 years participated in the survey, 302 (2.1%) of them tested positive, 92.2% (95% CI: 89.2-95.2) reported tested once for HIV. Overall, 78.2% (95% CI: 72.4-84) reported to be aware of their status and on ART. 70.5% (95% CI: 63.8-77.2) reported to have suppressed viral load. Married or living together with a partner showed to be 7 times more likely to be on ART vs single or never married (OR: 7.42, 95% CI: (1.75;31.38), P <0.01). Odds of viral load suppression increases with age, and those aged above 55 years showed to be more suppressing their virus (OR: 3.94, (95% CI: 0.92-16.9), P=0.07). Findings from this study revealed the gaps to be closed to include all population in maximizing HIV service delivery.

scholarly journals A comparison of medication adherence and viral suppression in antiretroviral treatment-naïve patients with HIV/AIDS depending on the drug formulary

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245185
Author(s):  
Kyung Sun Oh ◽  
Euna Han
Keyword(s):  
Viral Load ◽  
Medication Adherence ◽  
Antiretroviral Treatment ◽  
Art Adherence ◽  
Pill Burden ◽  
Viral Load Suppression ◽  
Hiv Rna ◽  
Single Tablet Regimen ◽  
Treatment Naïve ◽  
Hiv Aids

Antiretroviral treatment (ART) adherence is highlighted in management of patients living with human immunodeficiency virus. In South Korea, ART medication research has rarely been conducted due to the low economic burden associated with government-funded treatment. This cross-sectional study aimed to compare the pill burden impact between ART regimen compliance and HIV-RNA viral load suppression. Data were collected from 2008 to 2016 at a general hospital in South Korea. A total of 210 HIV/AIDS treatment-naïve patients were grouped as follows: single-tablet regimen (STR, one tablet/day), mild pill burden (two-four tablets/day), and heavy pill burden (≥ five tablets/day). Patients were analyzed according to gender, age at index date, medical insurance type, comorbidities, depression, HIV/AIDS disease burden as indicated by HIV-RNA viral load and CD4, and laboratory variables. In a multivariate logistic regression model, the STR group demonstrated adherence 5.10 times more often than the heavy pill burden group. Females and patients with an initial viral load of 500,000 or more were 0.090- and 0.040-fold less adherent to the ART regimen. Among these patients, 95% or more of the MPR group were 7.38 times more likely to have a lower limit of detection (LLOD) of viral load suppression. The highest initial viral load group was 0.090-fold less likely to have an LLOD than the reference group. These results suggest that a single-tablet regimen could improve medication adherence and the clinical virologic outcome. Therefore, general population research on ART adherence and polypharmacy is needed.

The Impact of Delayed Hepatitis C Viral Load Suppression on Patient Risk: Historical Evidence from the Veterans Administration

2016 ◽  
Vol 19 (2) ◽  
pp. 333-351 ◽  
Author(s):  
Tara Matsuda ◽  
Jeffrey S. McCombs ◽  
Ivy Tonnu-Mihara ◽  
Justin McGinnis ◽  
D. Steven Fox
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Viral Load Suppression ◽  
Clinical Registry ◽  
Patient Risk ◽  
Viral Response ◽  
Clinical Events ◽  
The Impact

Abstract Background: The high cost of new hepatitis C (HCV) treatments has resulted in “watchful waiting” strategies being developed to safely delay treatment, which will in turn delay viral load suppression (VLS). Objective: To document if delayed VLS adversely impacted patient risk for adverse events and death. Methods: 187,860 patients were selected from the Veterans Administration’s (VA) clinical registry (CCR), a longitudinal compilation of electronic medical records (EMR) data for 1999–2010. Inclusion criteria required at least 6 months of CCR/EMR data prior to their HCV diagnosis and sufficient data post-diagnosis to calculate one or more FIB-4 scores. Primary outcome measures were time-to-death and time-to-a composite of liver-related clinical events. Cox proportional hazards models were estimated separately using three critical FIB-4 levels to define early and late viral response. Results: Achieving an undetectable viral load before the patient’s FIB-4 level exceed pre-specified critical values (1.00, 1.45 and 3.25) effectively reduced the risk of an adverse clinical events by 33–35% and death by 21–26%. However, achieving VLS after FIB-4 exceeds 3.25 significantly reduced the benefit of viral response. Conclusions: Delaying VLS until FIB-4 >3.25 reduces the benefits of VLS in reducing patient risk.

scholarly journals Declines in HIV incidence among men and women in a South African population-based cohort

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Alain Vandormael ◽  
Adam Akullian ◽  
Mark Siedner ◽  
Tulio de Oliveira ◽  
Till Bärnighausen ◽  
...  
Keyword(s):  
South African ◽  
Scale Up ◽  
Hiv Infections ◽  
Population Based ◽  
Hiv Incidence ◽  
Prevention Services ◽  
Incidence Trends ◽  
The Past ◽  
Massive Scale ◽  
The Impact

AbstractOver the past decade, there has been a massive scale-up of primary and secondary prevention services to reduce the population-wide incidence of HIV. However, the impact of these services on HIV incidence has not been demonstrated using a prospectively followed, population-based cohort from South Africa—the country with the world’s highest rate of new infections. To quantify HIV incidence trends in a hyperendemic population, we tested a cohort of 22,239 uninfected participants over 92,877 person-years of observation. We report a 43% decline in the overall incidence rate between 2012 and 2017, from 4.0 to 2.3 seroconversion events per 100 person-years. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), which is consistent with male circumcision scale-up and higher levels of female antiretroviral therapy coverage. Additional efforts are needed to get more men onto consistent, suppressive treatment so that new HIV infections can be reduced among women.

scholarly journals Population-based HIV prevalence, stigma and HIV risk among trans women in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Erin C. Wilson ◽  
Manisha Dhakal ◽  
Sanjay Sharma ◽  
Anuj Rai ◽  
Rajesh Lama ◽  
...  
Keyword(s):  
Sex Work ◽  
Hiv Risk ◽  
Population Based ◽  
Hiv Prevalence ◽  
Mental Wellbeing ◽  
Receptive Anal Intercourse ◽  
Key Populations ◽  
Depression And Anxiety ◽  
Trans Women ◽  
The Impact

Abstract Background Transgender women (trans women) in Nepal are underserved in the HIV response. Data are needed to determine the HIV prevalence disaggregated from other key populations and to identify the particular risks faced by this community. Trans women are marginalized around the world and research is also needed to determine the impact of stigma on HIV risk to inform trans-specific interventions. Methods In 2019, we conducted the first population-based HIV behavioral surveillance study of trans women disaggregated from other key populations using respondent driven sampling (RDS). We estimated the HIV prevalence for trans women, and bivariate and multivariate Poisson binomial regression models were constructed to examine the relationship between HIV risk and stigma. Results Trans women participants (N = 200) had a mean age of 33 years old (SD = 10.96). We found a weighted HIV prevalence of 11.3% (95% CI 6·82% - 18·13). We found that depression and anxiety (aPR 0.81; 95% CI 0.67–0.97; p = 0·02) and current engagement in sex work (aPR 1.31; 95% CI 1.01–1.71; p = 0·046) were significantly associated with greater prevalence of condomless receptive anal intercourse. We found that experienced stigma of ever being verbally abused due to gender identity was significantly associated with lower prevalence of depression and anxiety (aPR 0.42; 95% CI 0.20–0.87; p = 0·002). Feeling unaccepted in Nepali society and believing people thought they were a criminal because of their trans identity was significantly associated greater prevalence of current sex work (aPR 1.36; 95% CI 1.03–1.78; p = 0·03; aPR 1.45; 95% CI 1.03–2.07; p = 0.04). Every measure of experienced stigma assessed was significantly associated with greater prevalence of current engagement in sex work. Conclusions Trans women are highly stigmatized in Nepal, leading to individual and systems factors that impact their risk for HIV. Interventions are needed that support the economic and mental wellbeing of trans women to prevent their heighted risk of HIV from stigma.

scholarly journals Impact of HIV-1 CRF55_01B infection on the evolution of CD4 count and plasma HIV RNA load in men who have sex with men prior to antiretroviral therapy

2021 ◽  
Author(s):  
Lan Wei ◽  
Hao Li ◽  
Xing Lv ◽  
Chenli Zheng ◽  
Guilian Li ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Cd4 Count ◽  
Transmission Risk ◽  
Mixed Effect ◽  
Cd4 Cell Count ◽  
Hiv Rna ◽  
Subtype B ◽  
The Impact ◽  
Hiv 1

Abstract Background CRF55_01B is a newly identified HIV-1 circulating recombinant form originated from MSM in China. However, its impact on the disease progression and transmission risk has not been investigated. This study aimed to determine the impact of CRF55_01B infection on viral dynamics and immunological status, so as to provide implications for future prevention, treatment, or target interventions. Linear mixed effect models were applied to evaluate CD4 cell count decline and viral load increase by subtype.Results Of the 3418 blood samples, 1446 (42.3%) were CRF07_BC, 1169 (34.2%) CRF01_AE, 467 (13.7%) CRF55_01B, 249 (7.3%) type B, and 87 (2.5%) other subtypes (CRF_08BC, CRF_01B, C). CRF55_01B had replaced subtype B as the third predominant strain since 2012 in Shenzhen, China. CRF55_01B-infected MSM showed lower median of CD4 count than CRF07_BC-infected MSM (349.5 [IQR, 250.2~474.8] vs 370.0 [IQR, 278.0~501.0], P<0.05). CRF55_01B infection was associated with slower loss of CD4 count than CRF01_AE (13.6 vs 23.3 [cells/μL]¹/²/year, P<0.05)among MSM with initial CD4 count of 200~350 cells/μL. On the other hand, those infected with CRF55_01B showed higher median plasma HIV RNA load (5.4 [IQR, 5.0~5.9]) than both CRF01_AE (5.3 [IQR, 4.8~5.7], P<0.05) and CRF07_BC (5.0 log10 [IQR, 4.5~5.5], P<0.001) at the initiation of antiretroviral therapy. Furthermore, the annual increasing rate of viral load for CRF55_01B infection was significantly higher than that of CRF07_BC (2.0 vs 0.7 log10 copies/ml/year, P<0.01).Conclusions The relatively lower CD4 count and faster increase of plasma HIV RNA load of CRF55_01B-infected MSM without antiretroviral therapy suggest that CRF55_01B may lead to longer asymptomatic phase and higher risk of HIV transmission. Strengthened surveillance, tailored prevention strategies and interventions, and in-depth research focusing on CRF55_01B are urgently needed to forestall potential epidemic.

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