HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial

Floyd, Sian; Shanaube, Kwame; Yang, Blia; Schaap, Albertus; Griffith, Sam; Phiri, Mwelwa; Macleod, David; Sloot, Rosa; Sabapathy, Kalpana; Bond, Virginia; Böck, Peter; Ayles, Helen; Fidler, Sarah; Hayes, Richard; Team, Hptn Study

doi:10.1371/journal.pmed.1003067

Cited by 26 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As prevalence among women was 2.0 times as high as prevalence among men in the HPTN 071 (PopART) study, the number of new infections from young men per infected young man was 2.93 times the same number for young women. Men in this age group were less likely than other demographic groups to be linked to care and on ART 27 . These results highlight the need for more intensive efforts in UTT programmes to achieve high coverage of men aged 25-40 and suggest that pre-exposure prophylaxis services should also be considered, particularly for young women 28,29 .…”

Section: Discussionmentioning

confidence: 83%

“…They were the sources for twice as many transmissions as the female risk group aged [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] with the same characteristics and almost twice as many transmissions as all sources outside these two age groups. These groups were followed by the same groups who were infected less than a year before transmission, were registered in a different community, and whose dominant viral population was resistant to first-line ART.…”

Section: Combined Characteristics Of Sourcesmentioning

confidence: 99%

See 1 more Smart Citation

Demographics of people who transmit HIV-1 in Zambia: a molecular epidemiology analysis in the HPTN-071 PopART study

Hall

Golubchik

Bonsall

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

BACKGROUND In the last decade, universally available antiretroviral therapy has led to reduced HIV incidence in sub-Saharan Africa. Sources of remaining transmission need to be characterised to design effective prevention strategies. METHODS We used phylogenetics to understand the population characteristics of people who are sources of infection. HIV samples from 6,864 individuals from Zambia were deep-sequenced as part of HPTN 071-02 (PopART) Phylogenetics between 2014 and 2018. We identified 300 likely directed transmission pairs and analysed their sources to better understand transmission in the general population. RESULTS After demographic weighting of the recipient population to match the estimated total population infected during the trial period, 59.4% (95% CI: 53.1%-65.8%) of transmissions were male-to-female, with 43.1% (36.6%-49.5%) of transmissions from males aged 25-40. Since the adult HIV prevalence was 2.0 times higher in women than men, the per-capita transmission rate was 2.93 times higher per infected male than per infected female. 25.6% (19.9%-31.3%) of sources were estimated to have themselves been infected less than a year before the transmission event. 16.8% (12%-21.7%) of sources transmitted viruses resistant to first-line ART. 13% (8.6%-17.4%) of transmissions occurred between individuals from different study communities. CONCLUSIONS Our findings suggest that HIV transmission in the study communities took place as part of common sexual mixing, and that there was no outsized contribution of importation, from drug resistance, or recent infection. Men aged 25-40 should be the focus of treatment for prevention interventions, even if linking them to care requires more effort.

show abstract

Section: Discussionmentioning

confidence: 83%

Section: Combined Characteristics Of Sourcesmentioning

confidence: 99%

Demographics of people who transmit HIV-1 in Zambia: a molecular epidemiology analysis in the HPTN-071 PopART study

Hall

Golubchik

Bonsall

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The proportions of key indicators (uptake of HIV testing, knowledge of HIV status, ART coverage, time to initiate ART, and retention on ART) are disaggregated by country, sex, and age group. The analysis was limited to R3 because (1) in R1, we did not have ethics permission to collect data from those aged <18 years; (2) data had previously been published from four of the Zambian communities in the first year of the P-ART-Y study [ 14 ]; and (3) reliable data were not available from SA in the previous rounds [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…All analyses were repeated separately for Arms A and B to investigate whether any stark differences could help explain the final PopART trial results [ 15 , 16 ]. In the PopART trial, HIV incidence differed quite substantially between Arms A and B, with Arm B having a lower incidence than Arm A (despite Arm A having the slightly more intensive intervention for the early period of the study).…”

Section: Methodsmentioning

confidence: 99%

HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

Shanaube

Macleod

Chaila

et al. 2021

Journal of Adolescent Health

Self Cite

View full text Add to dashboard Cite

Purpose The PopART for Youth (P-ART-Y) study was nested within the HPTN 071 (PopART) trial, a three-arm community randomized trial in 21 communities in Zambia and South Africa. The P-ART-Y study evaluated the acceptability and uptake of a combination HIV prevention package among young people. We report on the HIV care cascade for adolescents aged 10–19 years from 14 communities receiving the full HIV prevention package in Zambia and South Africa. Methods Adolescents were offered participation in the PopART intervention, which included universal home-based HIV testing, linkage to care, antiretroviral therapy (ART) adherence, and other services. Data were collected from September 2016 to December 2017, covering the third round (R3) of the intervention. Results We enumerated (listed) 128,241 adolescents (Zambia: 95,295 and South Africa: 32,946). Of the adolescents offered HIV testing, 81.9% accepted in Zambia and 70.3% in South Africa. Knowledge of HIV status was higher among older adolescents and increased from 31.4% before R3 to 88.3% at the end of R3 in Zambia and from 28.3% to 79.5% in South Africa. Overall, there were 1,710 (1.9%) adolescents identified as living with HIV by the end of R3 (515 new diagnoses and 1,195 self-reported). Of the new diagnoses, 335 (65.0%) were girls aged 15–19 years. The median time to initiate ART was 5 months. ART coverage before and after R3 increased from 61.3% to 78.7% in Zambia and from 65.6% to 87.8% in South Africa, with boys having higher uptake than girls in both countries. Conclusions The PopART intervention substantially increased coverage toward the first and second UNAIDS 90-90-90 targets in adolescents.

show abstract

“…The use of antiretroviral therapy (ART) has resulted in substantial reductions in HIV/AIDS-related morbidity and mortality worldwide [ 1 – 4 ]. Maintaining plasma HIV RNA suppression below the limit of quantification is the goal of ART, which induces persistent suppression of HIV replication and gradual recovery of CD4 cell counts [ 3 – 5 ]. Durable viral suppression is accomplished with sustained ART adherence in the majority of people living with HIV (PLWH).…”

Section: Introductionmentioning

confidence: 99%

Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in China

et al. 2022

View full text Add to dashboard Cite

Background Maintaining plasma HIV RNA suppression below the limit of quantification is the goal of antiretroviral therapy (ART). When viral loads (VL) remain in low-level viremia (LLV), or between 201 and 999 copies/mL, the clinical consequences are still not clear. We investigated the occurrence of LLV with drug resistance and its effect on CD4 cell counts in a large Chinese cohort. Methods We analysed data of 6,530 ART-experienced patients (42.1 ± 10.9 years; 37.3% female) from the China’s national HIV drug resistance (HIVDR) surveillance database. Participants were followed up for 32.9 (IQR 16.7–50.5) months. LLV was defined as the occurrence of at least one viral load (VL) measurement of 50–200 copies/mL during ART. Outcomes were drug resistance associated mutations (DRAM) and CD4 cell counts levels. Results Among 6530 patients, 58.0% patients achieved VL less than 50 copies/mL, 27.8% with VL between 50 and 999 copies/mL (8.6% experienced LLV), and 14.2% had a VL ≥ 1000 copies/mL. Of 1818 patients with VL 50–999 copies/mL, 182 (10.0%) experienced HIVDR, the most common DRAM were M184I/V 28.6%, K103N 19.2%, and V181C/I/V 10.4% (multidrug resistance: 27.5%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 3.8, 95% CI 2.6–5.5, p < 0.01) comparing with those without HIVDR. Of 925 patients with VL ≥ 1000 copies/mL, 495 (53.5%) acquired HIVDR, the most common DRAM were K103N 43.8%, M184I/V 43.2%, M41L 19.0%, D67N/G 16.4%, V181C/I/V 14.5%, G190A/S 13.9% and K101E 13.7% (multidrug resistance: 75.8%), and patients with HIVDR had a higher risk of CD4 cell counts < 200 cells/μL (AOR 5.8, 95% CI 4.6–7.4, p < 0.01) comparing with those without HIVDR. Conclusion Persistent with VL 50–999 copies/mL on ART is associated with emerging DRAM for all drug classes, and patients in this setting were at increased risk of CD4 cell counts < 200 cells/μL, which suggest resistance monitoring and ART optimization be earlier considered.

show abstract

HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial

Abstract: ¶ Membership of the HPTN 071 (PopART) Study Team is provided in the Acknowledgements.

Cited by 26 publications

References 19 publications

Demographics of people who transmit HIV-1 in Zambia: a molecular epidemiology analysis in the HPTN-071 PopART study

Demographics of people who transmit HIV-1 in Zambia: a molecular epidemiology analysis in the HPTN-071 PopART study

HIV Care Cascade Among Adolescents in a “Test and Treat” Community-Based Intervention: HPTN 071 (PopART) for Youth Study

Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in China

Contact Info

Product

Resources

About