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 Laeyendecker, Maria J. Wawer, Larry W. Chang, Thomas C. Quinn, Joseph Kagaayi, Aaron A.R. Tobian, Steven J. 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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