Lack of Virological Suppression Among Young HIV-Positive Adults in Botswana

Novitsky, Vlad; Gaolathe, Tendani; Mmalane, Mompati; Moyo, Sikhulile; Chakalisa, Unoda; Yankinda, Etienne Kadima; Marukutira, Tafireyi; Holme, Molly Pretorius; Sekoto, Tumalano; Gaseitsiwe, Simani; Musonda, Rosemary; Widenfelt, Erik van; Powis, Kathleen M.; Khan, Nealia; Dryden‐Peterson, Scott; Bennett, Kara; Wirth, Kathleen; Tchetgen, Eric Tchetgen; Bachanas, Pam; Mills, Lisa; Lebelonyane, Refeletswe; El-Halabi, Shenaaz; Makhema, Joseph; Lockman, Shahin; Essex, Max

doi:10.1097/qai.0000000000001715

Cited by 15 publications

(11 citation statements)

References 22 publications

(18 reference statements)

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“…According to gender, females are more likely to experience virological success than men 80.9% vs 75.9% respectively, p = 0.013). Even though the recent CAMPHIA study reported a relatively higher VS in men than women (80.1% vs 79.2%) [9], data from many studies suggest that men are likely to experience virological failure than females [4, 15]. This can be justified by their high risk related behavioural patterns.…”

Section: Discussionmentioning

confidence: 99%

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of “test and treat”

et al. 2019

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BackgroundAfter the launching of the « Test & Treat » strategy and the wider accessibility to viral load (VL), evaluating virological success (VS) would help in meeting the UNAIDS targets by 2020 in Cameroon.Setting and methodsCross-sectional study conducted in the Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB), Yaoundé, Cameroon; data generated between October 2016 and August 2017 amongst adults, adolescents and children at 12, 24, 36 and ≥ 48 months on ART. VS was defined as < 1000 copies/mL of blood plasma and controlled viremia as VL < 50 copies/mL. Data were analysed by SPSS; p < 0.05 considered as significant.Results1946 patients (70% female) were enrolled (1800 adults, 105 adolescents, 41 children); 1841 were on NNRTI-based and 105 on PI-based therapy; with 346 patients at M12, 270 at M24, 205 at M36 and 1125 at ≥ M48. The median (IQR) duration on was 48 months (24–48). Overall, VS was 79.4% (95% CI 77.6–81.2) and 67.1% (95% CI 64.9–69.1) had controlled viral replication. On NNRTI-based, VS was 79.9% vs. 71.4% on PIs-based, p = 0.003. By ART duration, VS was 84.1% (M12), 85.9% (M24), 75.1% (M36) and 77.2% (≥ M48), p = 0.001. By age, VS was 75.6% (children), 53.3% (adolescents) and 81.1% (adults), p < 0.001.ConclusionsIn this sub-population of patients receiving ART in Cameroon, about 80% might be experiencing VS, with declining performance at adolescence, with NNRTI-based regimens, and as from 36 months on ART. Thus, improving VS may require an adapted adherence support mechanism, especially for adolescents with long-term treatment in resource-limited settings.

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Section: Discussionmentioning

confidence: 99%

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of “test and treat”

et al. 2019

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“…In this study, we estimated HIV incidence using a baseline cross-sectional sample from the Botswana Combination Prevention Project (BCPP; the Ya Tsie study) [ 2 , 38 , 39 ]. BCPP is an ongoing pair-matched, cluster-randomized clinical trial in 30 rural and peri-urban communities across Botswana.…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015

et al. 2018

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BackgroundBotswana is close to reaching the UNAIDS “90-90-90” HIV testing, antiretroviral treatment (ART), and viral suppression goals. We sought to determine HIV incidence in this setting with both high HIV prevalence and high ART coverage.MethodsWe used a cross-sectional approach to assessing HIV incidence. A random, population-based sample of adults age 16–64 years was enrolled in 30 rural and peri-urban communities as part of the Botswana Combination Prevention Project (BCPP), from October 2013 –November 2015. Data and samples from the baseline household survey were used to estimate cross-sectional HIV incidence, following an algorithm that combined Limiting-Antigen Avidity Assay (LAg-Avidity EIA), ART status (documented or by testing ARV drugs in plasma) and HIV-1 RNA load. The LAg-Avidity EIA cut-off normalized optical density (ODn) was set at 1.5. The HIV-1 RNA cut-off was set at 400 copies/mL. For estimation purposes, the Mean Duration of Recent Infection was 130 days and the False Recent Rate (FRR) was evaluated at values of either 0 or 0.39%.ResultsAmong 12,610 individuals participating in the baseline household survey, HIV status was available for 12,570 participants and 3,596 of them were HIV positive. LAg-Avidity EIA data was generated for 3,581 (99.6%) of HIV-positive participants. Of 326 participants with ODn ≤1.5, 278 individuals were receiving ART verified through documentation and were considered to represent longstanding HIV infections. Among the remaining 48 participants who reported no use of ART, 14 had an HIV-1 RNA load ≤400 copies/mL (including 3 participants with ARVs in plasma) and were excluded, as potential elite/viremic controllers or undisclosed ART. Thus, 34 LAg-Avidity-EIA-recent, ARV-naïve individuals with detectable HIV-1 RNA (>400 copies/mL) were classified as individuals with recent HIV infections. The annualized HIV incidence among 16–64 year old adults was estimated at 1.06% (95% CI 0.68–1.45%) with zero FRR, and at 0.64% (95% CI 0.24–1.04%) using a previously defined FRR of 0.39%. Within a subset of younger individuals 16–49 years old, the annualized HIV incidence was estimated at 1.29% (95% CI 0.82–1.77%) with zero FRR, and at 0.90% (95% CI 0.42–1.38%) with FRR set to 0.39%.ConclusionsUsing a cross-sectional estimate of HIV incidence from 2013–2015, we found that at the time of near achievement of the UNAIDS 90-90-90 targets, ~1% of adults (age 16–64 years) in Botswana’s rural and peri-urban communities became HIV infected annually.

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“…Despite the high prevalence of HIV/AIDS in Africa, the Highly Active Anti-retroviral Therapy (HAART) coverage is still low due to some reasons (2). In Africa, an estimated 66% of eligible people living with HIV were not receiving HAART in 2013 (3), only 45% of adults living with HIV were reported to know their HIV status, 86% of diagnosed persons were initiated on HAART, and an estimated 76% of persons on ART had achieved HIV viral load suppression in 2013 (4). The Uganda Population-based HIV Impact Assessment (UPHIA) results revealed that the country has made significant progress in reducing the HIV prevalence from 7.3% in 2011 to 6% in 2017.…”

Section: 0: Backgroundmentioning

confidence: 99%

Bottlenecks and Opportunities towards Achieving the Targeted 95-95-95 HIV Services in a Rural District in Eastern Uganda

Namenkere¹,

Stella²,

Linda³

et al. 2021

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Background: There are 1.3 million people living with HIV in Uganda of which 73% know their HIV-positive status, 67% of the HIV-positive patients on ART, and 60% are viral load suppressed. Uganda has made progress in reducing the HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the WHO target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in Bukedea district. Methods: A mixed-methods cross-sectional study was conducted in Bukedea district covering males and females aged 18-65 years who had consented to participate in the study. We used a purposive sampling procedure to select our study participants. Qualitative data was collected through focus group discussions, key informant interviews, and document reviews for quantitative data. Quantitative data were analyzed using STATA v 14 whereas qualitative data were analyzed using the thematic analysis approach. Results: The challenges were grouped as patient-related, medication-related, and facility-related challenges. The patient-related challenges were stigma, fear to take the drugs, poor nutrition, long distances, alcoholism, busy working schedules, domestic violence. The medication-related 2 challenges were side effects, pill burden. The facility-related challenges were inadequate pretest counseling, stockouts. The use of anti-retroviral drugs was common in piggery and poultry and the sources of these drugs were reported to be the people on ART and the health workers. The opportunities included home-based counseling, organizing more outreaches, counseling and health education, targeted testing, and strengthening the VHT networks. Conclusion: The study revealed that the major challenges towards achieving the targeted 95-95- 95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of Antiretroviral drugs in animal husbandry was common in Bukedea District. Continuous sensitization about HIV and the importance of adherence to drugs, continuous and adequate counseling of the clients on ART, and close monitoring of their viral load could help to improve enrollment into care, adherence to HIV treatment, and HIV viral load suppression.

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Lack of Virological Suppression Among Young HIV-Positive Adults in Botswana

Abstract: Young adults in Botswana are significantly less likely to have undetectable HIV-1 RNA load compared with older adults. In the era of broad scale-up of ART, interventions able to diagnose young adults living with HIV and link them to effective therapy are urgently needed.

Cited by 15 publications

References 22 publications

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of “test and treat”

Viral suppression in adults, adolescents and children receiving antiretroviral therapy in Cameroon: adolescents at high risk of virological failure in the era of “test and treat”

Cross-sectional estimates revealed high HIV incidence in Botswana rural communities in the era of successful ART scale-up in 2013-2015

Bottlenecks and Opportunities towards Achieving the Targeted 95-95-95 HIV Services in a Rural District in Eastern Uganda

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