Prevalence and Predictors of Persistent Human Immunodeficiency Virus Viremia and Viral Rebound after Universal Test and Treat: A Population-Based Study

M. Kate Grabowski, Eshan U. Patel, Gertrude Nakigozi, Victor Ssempijja, Robert Ssekubugu, Joseph Ssekasanvu, Anthony Ndyanabo, Godfrey Kigozi, Fred Nalugoda, Ronald H Gray, Sarah Kalibbala, David M. Serwadda, Oliver B. Laeyendecker, Maria Wawer, Larry W. Chang, Thomas C Quinn, Joseph Kagaayi, Aaron A.R. Tobian, Steven James Reynolds

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There are limited data on individual human immunodeficiency virus (HIV) viral load (VL) trajectories at the population-level after the introduction of universal test and treat (UTT) in sub-Saharan Africa. Methods: Human immunodeficiency virus VLs were assessed among HIV-positive participants through 3 population-based surveys in 4 Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (2 consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed VL suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95% confidence intervals (CIs) of persistent viremia were estimated using multivariate Poisson regression. Results: There were 1346 HIV-positive participants (n†=†1883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.8% to 13.3%. Younger age (15-29 vs 40-49 years; adjRR†=†1.80; 95% CI†=†1.19-2.71), male sex (adjRR†=†2.09, 95% CI†=†1.47-2.95), never being married (vs currently married; adjRR†=†1.88, 95% CI†=†1.34-2.62), and recent migration to the community (vs long-term resident; adjRR†=†1.91, 95% CI†=†1.34-2.73) were factors associated with persistent viremia. Conclusions: Despite increases in durable VL suppression during roll out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.

Original languageEnglish (US)
Pages (from-to)1150-1160
Number of pages11
JournalJournal of Infectious Diseases
Volume223
Issue number7
DOIs
StatePublished - Apr 1 2021

Keywords

  • Africa
  • HIV prevention
  • cohort studies
  • universal test and treat
  • viral suppression

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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