Two‐fold increase in the HIV viral load suppression rate along with decreased incidence over six years in Ndhiwa sub‐county, Kenya

Abstract

In the last decade, progress toward HIV epidemic control has accelerated to meet the 90-90-90 targets set by the Joint United Nation Programme on HIV/AIDS (UNAIDS) for 2020: that 90% of all population living with HIV (PLHIV) know their HIV status (first 90); 90% of people aware of their HIV-positive status receive sustained antiretroviral therapy

Changes Over Time in the Proportion of Advanced HIV Disease in Two High HIV Prevalence Settings in Ndhiwa (Kenya) and Eshowe (South Africa)

“…The cascade of care for PLHIV in the general population in Ndhiwa 2 was; status awareness 93.4% (91.7-94.8), those linked to care 91.8% (90.0-93.4), on ART 90.4% (88.5-92.1) and those with suppressed viral load 88.3% (86.1-90.1). 16 …”

“…Another important finding of our study is that although we found an improvement in the cascade of care coverage and 90-90-90 UNAIDS targets between the first and second surveys more especially in Kenya, we cannot claim the same when we compare cascade of care and the 90-90-90 UNAIDS target results for individuals with advanced HIV disease with that of the general population. The general population has succeeded in achieving the targets 1 year ahead of time in both settings 16 , 17 , 33 which is why we need to put more effort into identifying those PLHIV with advanced HIV through testing, initiating them on care and ART, and ensuring that they are retained. This suboptimal coverage of the cascade of care in those with advanced HIV risks derailing the efforts of reducing HIV-related mortality and morbidity which is high among people with advanced HIV disease.…”

“…15 Both Ndhiwa and Eshowe had above average country-level HIV prevalences which prompted MSF to open HIV projects and programs some of which specifically targeted PLHIV with advanced HIV to help the respective ministries contain the disease. 16 , 17 To identify PLHIV with advanced HIV, MSF had also been supporting the implementation of point-of-care CD4 cell count testing. Between 2012 and 2013, MSF carried out its first HIV surveys to collect baseline data on HIV burden and for use in the evaluation of the program's impact at the population level at a later stage.…”

Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review

“…Only 3 studies locally adapted both the MDRI and the FRR as part of the analysis [ 125 , 129 , 151 ]. One study locally adapted the MDRI by weighting for local subtype distribution but assumed 0 FRR [ 133 ], and 7 studies used a published MDRI but locally estimated the FRR based on internal data [ 114 , 120 , 121 , 123 , 132 , 138 , 143 ]. One study used an FRR of 0 for the main analysis, and compared incidence results with those generated assuming an FRR of 0.39% in a sensitivity analysis [ 124 ].…”

“…Among the 51 articles describing the use of recency assays for estimation of HIV incidence, 16 (31%) [101][102][103][104][105][106][107][108][109][110][111][112][113][114][115][116] described national surveillance in the form of population-based surveys (including 10 from the US-supported Population-based HIV Impact Assessment (PHIA) surveys). Another 12 (24%) [117][118][119][120][121][122][123][124][125][126][127][128] were also population-based surveys with a representative sampling strategy, but had a community-level (subnational) focus. Most evidence related to national or subnational incidence surveillance was judged to be "very strong" (10/28), "strong" (6/28), or "moderately strong" (…”