Progress towards the UNAIDS 90‐90‐90 targets among persons aged 50 and older living with HIV in 13 African countries

Farley, Shannon M.; Wang, Chunhui; Bray, Rachel; Low, Andrea; Delgado, Stephen; Hui‐Kang, David; Kakishozi, Angela N; Harris, Tiffany G.; Nyirenda, Rose; Wadonda, Nellie; Li, Michelle; Amuri, Mbaraka; Juma, James; Kancheya, Nzali; Pietersen, Ismela; Mutenda, Nicholus; Natanael, Salomo; Aoko, Appolonia; Ngugi, Evelyn; Asiimwe, Fred; Lecher, Shirley; Ward, Jennifer; Chikwanda, Prisca; Mugurungi, Owen; Moyo, Brian; Nkurunziza, Peter; Aibo, Dorothy; Kabala, Andrew; Biraro, Sam; Ndagije, Felix; Musuka, Godfrey; Ndongmo, Clement B; Shang, Judith; Dokubo, E. Kainne; Dimite, Laura E; McCullough-Sanden, Rachel; Bissek, Anne-Cécile Zoung Kanyi; Getaneh, Yimam; Eshetu, Frehywot; Nkumbula, Tepa; Tenthani, Lyson; Kayigamba, Felix; Kirungi, Wilford; Musinguzi, Joshua; Balachandra, Shirish; Kayirangwa, Eugenie; Ayite, Ayiyi; West, Christine; Bodika, Stephane; Sleeman, Katrina; Patel, Hetal; Brown, Kristin; Voetsch, Andrew C.; El‐Sadr, Wafaa; Justman, Jessica

doi:10.1002/jia2.26005

Cited by 15 publications

(11 citation statements)

References 40 publications

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“…Inverse probability weighting, nevertheless, helped mitigate potential biases induced by excluding unobserved visits from participants contributing two visits to the analytic cohort (Figure S3). Sixth, the study population was limited to individuals aged 15–49 years, so findings may not be transferable to adults aged 50+ years, whose viral load outcomes generally outperform those of younger populations [55, 56]. Lastly, while HIV epidemic characteristics of inland communities are comparable to settings outside the RCCS study area, findings from fishing communities may have more limited transferability to other contexts, given their unique demographic, behavioural and epidemiologic profiles [15, 16].…”

Section: Discussionmentioning

confidence: 99%

Temporal dynamics and drivers of durable HIV viral load suppression and persistent high‐ and low‐level viraemia during Universal Test and Treat scale‐up in Uganda: a population‐based study

Rosen,

Ssekubugu,

Chang

et al. 2024

J Int AIDS Soc.

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IntroductionPopulation‐level data on durable HIV viral load suppression (VLS) following the implementation of Universal Test and Treat (UTT) in Africa are limited. We assessed trends in durable VLS and viraemia among persons living with HIV in 40 Ugandan communities during the UTT scale‐up.MethodsIn 2015–2020, we measured VLS (<200 RNA copies/ml) among participants in the Rakai Community Cohort Study, a longitudinal population‐based HIV surveillance cohort in southern Uganda. Persons with unsuppressed viral loads were characterized as having low‐level (200–999 copies/ml) or high‐level (≥1000 copies/ml) viraemia. Individual virologic outcomes were assessed over two consecutive RCCS survey visits (i.e. visit‐pairs; ∼18‐month visit intervals) and classified as durable VLS (<200 copies/ml at both visits), new/renewed VLS (<200 copies/ml at follow‐up only), viral rebound (<200 copies/ml at initial visit only) or persistent viraemia (≥200 copies/ml at both visits). Population prevalence of each outcome was assessed over calendar time. Community‐level prevalence and individual‐level predictors of persistent high‐level viraemia were also assessed using multivariable Poisson regression with generalized estimating equations.ResultsOverall, 3080 participants contributed 4604 visit‐pairs over three survey rounds. Most visit‐pairs (72.4%) exhibited durable VLS, with few (2.5%) experiencing viral rebound. Among those with any viraemia at the initial visit (23.5%, n = 1083), 46.9% remained viraemic through follow‐up, 91.3% of which was high‐level viraemia. One‐fifth (20.8%) of visit‐pairs exhibiting persistent high‐level viraemia self‐reported antiretroviral therapy (ART) use for ≥12 months. Prevalence of persistent high‐level viraemia varied substantially across communities and was significantly elevated among young persons aged 15–29 years (vs. 40‐ to 49‐year‐olds; adjusted risk ratio [adjRR] = 2.96; 95% confidence interval [95% CI]: 2.21–3.96), males (vs. females; adjRR = 2.40, 95% CI: 1.87–3.07), persons reporting inconsistent condom use with non‐marital/casual partners (vs. persons with marital/permanent partners only; adjRR = 1.38, 95% CI: 1.10–1.74) and persons reporting hazardous alcohol use (adjRR = 1.09, 95% CI: 1.03–1.16). The prevalence of persistent high‐level viraemia was highest among males <30 years (32.0%).ConclusionsFollowing universal ART provision, most persons living with HIV in south‐central Uganda are durably suppressed. Among persons exhibiting any viraemia, nearly half exhibited high‐level viraemia for ≥12 months and reported higher‐risk behaviours associated with onward HIV transmission. Intensified efforts linking individuals to HIV treatment services could accelerate momentum towards HIV epidemic control.

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Section: Discussionmentioning

confidence: 99%

Temporal dynamics and drivers of durable HIV viral load suppression and persistent high‐ and low‐level viraemia during Universal Test and Treat scale‐up in Uganda: a population‐based study

Rosen,

Ssekubugu,

Chang

et al. 2024

J Int AIDS Soc.

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“…UNAIDS proposed the 95-95-95 strategy in 2021 with plans to achieve it by 2025 [23]. In sub-Saharan Africa, which has the largest number of older people with HIV globally [4], meeting these targets has been more successful with older as compared to younger adults [56]. UNAIDS does not have any plans to specifically address older adults with HIV, besides "A special supplement to the UNAIDS report," a five-page document published in 2013 (https://www.unaids.org/en/resources/presscentre/pressrele aseandstatementarchive/2013/november/20131101praging) .…”

Section: Programmatic and Policy Responses Programmatic Responsesmentioning

confidence: 99%

Aging with HIV: Working to Ensure Equity and Inclusion

Brennan-Ing¹,

Mattas²

2023

Gerontology

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Due to effective anti-retroviral therapy (ART), the people with HIV are aging, and this is observed globally wherever ART is readily available. While this represents the success of HIV treatment, those aging with HIV face several health challenges that emphasize the importance of access to health care and health equity. These challenges include changes to the immune system, chronic inflammation, and higher rates of multimorbidity at younger ages compared to people without HIV. Intersectional identities impact health care access and health equity and include age, sexual orientation, gender identity, race/ethnicity, socioeconomic position, and HIV serostatus. Intersectional identities are also associated with psychosocial burdens among older adults with HIV such as depression, social isolation, and HIV stigma. Social integration of older people with HIV can mitigate some of these burdens and is associated with better psychological well-being, better physical functioning, and greater sufficiency of informal social supports. There are several grassroots and advocacy initiatives to improve health equity and social integration which bring greater visibility to HIV and aging. These efforts should be coupled with a systematic and sustained policy response to the aging of this population that prioritizes human needs and is grounded in principles of social justice. Action must be taken, and this responsibility falls on policymakers, healthcare professionals, researchers, and community advocates alike.

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“…In 2021, these targets were increased to 95-95-95 (already met by 2 countries) in anticipation of continued improvements in care and access. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

Frey¹,

Johnston²,

Siegler³

2023

HIV

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With improved access to antiretroviral therapy throughout the world, people are aging with HIV, and a large portion of the global population of people with HIV (PWH) is now age 50 or older. Older PWH experience more comorbidities, aging-related syndromes, mental health challenges, and difficulties accessing fundamental needs than the population of older adults without HIV. As a result, ensuring that older PWH are receiving comprehensive healthcare can often be overwhelming for both PWH and the providers. Although there is a growing literature addressing the needs of this population, gaps remain in care delivery and research. In this paper, we suggest seven key components to any healthcare program designed to address the needs of older people with HIV: management of HIV, comorbidity screening and treatment, primary care coordination and planning, attention to aging related-syndromes, optimization of functional status, support of behavioral health, and improved access to basic needs and services. We review many of the difficulties and controversies related to the implementation of these components, which include the absence of screening guidelines for this population and the challenges of care integration, and we suggest key next steps.

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Progress towards the UNAIDS 90‐90‐90 targets among persons aged 50 and older living with HIV in 13 African countries

Cited by 15 publications

References 40 publications

Temporal dynamics and drivers of durable HIV viral load suppression and persistent high‐ and low‐level viraemia during Universal Test and Treat scale‐up in Uganda: a population‐based study

Temporal dynamics and drivers of durable HIV viral load suppression and persistent high‐ and low‐level viraemia during Universal Test and Treat scale‐up in Uganda: a population‐based study

Aging with HIV: Working to Ensure Equity and Inclusion

Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough?

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