Community viral load, antiretroviral therapy coverage, and HIV incidence in India: a cross-sectional, comparative study

Solomon, Sunil S.; Mehta, Shruti H.; McFall, Allison M.; Srikrishnan, Aylur K.; Saravanan, S.; Laeyendecker, Oliver; Balakrishnan, Pachamuthu; Celentano, David D.; Solomon, Suniti; Lucas, Gregory M.

doi:10.1016/s2352-3018(16)00019-9

Cited by 72 publications

(90 citation statements)

References 27 publications

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“…Although earlier multi‐city studies in other countries emphasized the influence of HIV seroprevalence on HIV incidence rates among PWID, more recent studies suggest that community viral suppression, regardless of HIV seroprevalence rate, is a stronger predictor of HIV incidence in high‐risk populations . In this study and previous studies, we show better awareness of HIV status and greater community viral suppression among PWID in the Northeast compared to those in the North/Central region . Despite higher HIV prevalence in the Northeast, the overall lower HIV incidence in this region, including among emerging‐ and young‐adult PWID, is likely a result of these factors.…”

Section: Discussionsupporting

confidence: 47%

Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross‐sectional study

et al. 2019

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Introduction There are limited data on young people who inject drugs ( PWID ) from low‐ and middle‐income countries where injection drug use remains a key driver of new HIV infections. India has a diverse injection drug use epidemic and estimates suggest that at least half of PWID are ≤30 years of age. We compared injection and sexual risk behaviours and HIV incidence between younger and older PWID and characterized uptake of HIV testing and harm reduction services to inform targeted HIV prevention efforts. Methods We analysed cross‐sectional data from 14,381 PWID recruited from cities in the Northeast and North/Central regions of India in 2013 using respondent driven sampling ( RDS ). We compared “emerging‐adult” (18 to 24 years, 26% of sample) and “young‐adult” PWID (25 to 30 years, 30% of sample) to older PWID (>30 years, 44% of sample) using logistic regression to evaluate factors associated with three recent risk behaviours: needle‐sharing, multiple sexual partners and unprotected sex. We estimated age‐stratified cross‐sectional HIV incidence using a validated multi‐assay algorithm. Results Compared to older adults, emerging‐adults in the Northeastern states were significantly more likely to share needles (males adjusted odds ratio [ aOR ] 1.82; females aOR 2.29, p < 0.01), have multiple sexual partners (males aOR 1.56; females aOR 3.75, p < 0.01), and engage in unprotected sex (males aOR 2.29, p < 0.01). In the North/Central states, young‐adult males were significantly more likely to needle‐share ( aOR 1.23, p < 0.05) while emerging‐adult males were significantly more likely to have multiple sexual partners ( aOR 1.74, p < 0.05). In both regions, emerging‐adults had the lowest HIV testing. Participation in harm reduction services was low across all age groups. Annual HIV incidence was higher in emerging‐ and young‐adult PWID in the North/Central region: emerging‐adults: 4.3% (95% confidence interval [ CI ] 3.0, 5.6); young‐adults: 4.9% (95% CI 3.7, 6.2); older adults: 2.1% (95% CI 1.4, 2.8). Conclusions Higher HIV incidence an...

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Section: Discussionsupporting

confidence: 47%

Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross‐sectional study

et al. 2019

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“…We use the term community due to lacking clear geographic bounded subdivision of land34, signifying larger unit compared to that of neighborhood in our study. As a major predictor of HIV incidence,35 a geospatial grid-based technique using the GIS was utilized to construct a community-based HIV prevalence estimate for each study years. This estimate was computed by means of a moving two-dimensional Gaussian kernel of 3 km search radius, a method consistent with our previous study 36.…”

Section: Methodsmentioning

confidence: 99%

Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa

Tomita

Vandormael

Bärnighausen

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Few population-based multilevel studies have quantified the risks that social context poses in rural communities with high HIV incidence across South Africa. We investigated the individual, social and community challenges to HIV acquisition risk in areas with high and low incidence of HIV infection (hotspots/coldspots). Methods The cohort (N=17,376) included all HIV-negative adults enrolled in a population-based HIV surveillance study from 2004–2015 in a rural South African community with a large labor migrancy. Multilevel survival models were fitted to examine the social determinants (i.e. neighborhood migration intensity), community traits (i.e. HIV prevalence), and individual determinants of HIV acquisition risk in identified hotspots/coldspots. Results The HIV acquisition risk (aHR=1.05, 95% CI:1.01-1.09) was greater in hotspots with a higher neighborhood migration intensity amongst men. In women, higher neighborhood migration intensity (aHR=1.02, 95% CI:1.01-1.02) was associated with a greater HIV acquisition risk, irrespective of whether they lived in hotspot/coldspot communities. HIV acquisition risk was greater in communities with a higher prevalence of HIV in both men (aHR=1.07, 95% CI:1.03-1.12) and women (aHR=1.03, 95% CI:1.01-1.05), irrespective of hotspot/coldspot locations. Conclusion HIV acquisition risk was strongly influenced by gender (i.e. young women), behavior (i.e. sexual debut, contraception, circumcision) and social determinants. Certain challenges (i.e. community disease prevalence) for HIV acquisition risk impacted both sexes, regardless of residence in hotspot/coldspot communities, while social determinants (i.e. neighborhood migration intensity) were pronounced in hotspots among men. Future intervention scale-up requires addressing the social context that contributes to HIV acquisition risk in rural areas with high migration.

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“…Case studies of key populations viral load monitoring opportunities and challenges Solomon et al[23].…”

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confidence: 99%

HIV viral load monitoring among key populations in low‐ and middle‐income countries: challenges and opportunities

et al. 2017

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IntroductionKey populations bear a disproportionate HIV burden and have substantial unmet treatment needs. Routine viral load monitoring represents the gold standard for assessing treatment response at the individual and programme levels; at the population‐level, community viral load is a metric of HIV programme effectiveness and can identify “hotspots” of HIV transmission. Nevertheless, there are specific implementation and ethical challenges to effectively operationalize and meaningfully interpret viral load data at the community level among these often marginalized populations.DiscussionViral load monitoring enhances HIV treatment, and programme evaluation, and offers a better understanding of HIV surveillance and epidemic trends. Programmatically, viral load monitoring can provide data related to HIV service delivery coverage and quality, as well as inequities in treatment access and uptake. From a population perspective, community viral load data provides information on HIV transmission risk. Furthermore, viral load data can be used as an advocacy tool to demonstrate differences in service delivery and to promote allocation of resources to disproportionately affected key populations and communities with suboptimal health outcomes. However, in order to perform viral load monitoring for individual and programme benefit, health surveillance and advocacy purposes, careful consideration must be given to how such key population programmes are designed and implemented. For example, HIV risk factors, such as particular sex practices, sex work and drug use, are stigmatized or even criminalized in many contexts. Consequently, efforts must be taken so that routine viral load monitoring among marginalized populations does not cause inadvertent harm. Furthermore, given the challenges of reaching representative samples of key populations, significant attention to meaningful recruitment, decentralization of care and interpretation of results is needed. Finally, improving the interoperability of health systems through judicious use of biometrics or identifiers when confidentiality can be maintained is important to generate more valuable data to inform monitoring programmes.ConclusionsOpportunities for expanded viral load monitoring could and should benefit all those affected by HIV, including key populations. The promise of the increasing routinization of viral load monitoring as a tool to advance HIV treatment equity is great and should be prioritized and appropriately implemented within key population programmatic and research agendas.

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Community viral load, antiretroviral therapy coverage, and HIV incidence in India: a cross-sectional, comparative study

Cited by 72 publications

References 27 publications

Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross‐sectional study

Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross‐sectional study

Social Disequilibrium and the Risk of HIV Acquisition: A Multilevel Study in Rural KwaZulu-Natal Province, South Africa

HIV viral load monitoring among key populations in low‐ and middle‐income countries: challenges and opportunities

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