TY - JOUR
T1 - Prevalence and Predictors of Persistent Human Immunodeficiency Virus Viremia and Viral Rebound after Universal Test and Treat
T2 - A Population-Based Study
AU - Grabowski, M. Kate
AU - Patel, Eshan U.
AU - Nakigozi, Gertrude
AU - Ssempijja, Victor
AU - Ssekubugu, Robert
AU - Ssekasanvu, Joseph
AU - Ndyanabo, Anthony
AU - Kigozi, Godfrey
AU - Nalugoda, Fred
AU - Gray, Ronald H.
AU - Kalibbala, Sarah
AU - Serwadda, David M.
AU - Laeyendecker, Oliver
AU - Wawer, Maria J.
AU - Chang, Larry W.
AU - Quinn, Thomas C.
AU - Kagaayi, Joseph
AU - Tobian, Aaron A.R.
AU - Reynolds, Steven J.
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
PY - 2021/4/1
Y1 - 2021/4/1
N2 - 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.
AB - 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.
KW - Africa
KW - HIV prevention
KW - cohort studies
KW - universal test and treat
KW - viral suppression
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U2 - 10.1093/infdis/jiab021
DO - 10.1093/infdis/jiab021
M3 - Article
C2 - 33471100
AN - SCOPUS:85104160113
SN - 0022-1899
VL - 223
SP - 1150
EP - 1160
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 7
ER -