Categorical testing of the viral load of people living with HIV to measure the intensity of the epidemic and the effectiveness of the response in the community: a prospective cohort study in Xinjiang China

Abstract

Background: New indicators of HIV transmission potential are being actively explored. We aim to categorical testing of the viral load of people living with HIV in order to explore new indicators to measure the intensity of the epidemic and the effectiveness of the response in the community. Methods: A dynamic cohort study was conducted in Yining to monitor the viral load (VL) of all individuals with HIV/AIDS from 2017 to 2019. Different PVL surrogate values were calculated and the strength of the associations between different PVL surrogates and HIV new incidence, antiretroviral therapy (ART) coverage, virus unsuppression, and viremia prevalence was assessed. Then we used PVL surrogate markers to describe the current status of HIV transmission potential in different characteristic populations and different communities. Results: All the values of different PVL indicators showed a decreasing trend year by year (P < 0.05). A significant correlation was observed between the decrease in community viral load (CVL) alone and the increase in the incidence of new HIV infections. Mean CVL (r = 1.000, P = 0.006), geometric mean CVL (r = 1.000, P = 0.001) were positively associated with HIV new infection. Both before and after imputation with missing values showed that mean CVL and geometric mean CVL were significantly associated with ART coverage and viral unsuppression (P < 0.05). Relatively high CVLs were found for males, ≤25 years of age, elementary school or less, other place of domicile, other type of health insurance, other source of sample, nonmarital noncommercial heterosexual contact, and nonmarital commercial heterosexual contact in the different characteristics groups. Community-based cross-sectional analyses showed a positive correlation between CVL, Viral unsuppression rate, and Viremia prevalence, and a negative correlation between ART coverage rate and the first three indicators, suggesting that “community 10” is the hotspot for HIV epidemics in the city. Conclusions: CVL can be used as an indicator evaluate the HIV transmission potential. To further reduce the HIV transmission potential, targeted interventions should be developed on key populations and hotspot communities.