High levels of viral load monitoring and viral suppression under Treat All in Rwanda – a cross‐sectional study

Ross, Jonathan; Ribakare, Muhayimpundu; Remera, Eric; Murenzi, Gad; Munyaneza, Athanase; Hoover, Donald R.; Shi, Qiuhu; Nsanzimana, Sabin; Yotebieng, Marcel; Nash, Denis; Anastos, Kathryn

doi:10.1002/jia2.25543

Cited by 21 publications

(29 citation statements)

References 19 publications

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“…Overall 46 studies [2,20‐24,26‐30,32,40,43,45,49‐51,53,61,63,65,68,69,72,74‐94] reported on retention on ART or being on ART and 34 (74%) provided clear definitions of numerators and denominators. The majority of studies were longitudinal (29 studies, 63%), 13 were cross‐sectional and four of mixed design.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 52 studies reported numbers or percentages of patients retained at this step [8,20‐32,34,36,40‐43,46,56,58,65,68,69,72‐74,76‐93,95‐99]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies reported on retention in pre‐ART care [ 2 , 20 , 26 , 27 , 34 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], with 12 defining numerators and denominators. Six studies were cross‐sectional and 13 longitudinal.…”

Section: Resultsmentioning

confidence: 99%

“…Overall 46 studies [ 2 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 32 , 40 , 43 , 45 , 49 , 50 , 51 , 53 , 61 , 63 , 65 , 68 , 69 , 72 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 ] reported on retention on ART or being on ART and 34 (74%) provided clear definitions of numerators and denominators. The majority of studies were longitudinal (29 studies, 63%), 13 were cross‐sectional and four of mixed design.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 52 studies reported numbers or percentages of patients retained at this step [8,[20][21][22][23][24][25][26][27][28][29][30][31][32]34,36,[40][41][42][43]46,56,58,65,68,69,[72][73][74][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][95][96][97][98][99]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”

Section: Viral Suppressionmentioning

confidence: 99%

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The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Introduction:The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013(IQR to 2019. The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Viral Suppressionmentioning

confidence: 99%

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The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Effect of a Multisectoral Agricultural Intervention on HIV Health Outcomes Among Adults in Kenya

et al. 2022

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ImportanceFood insecurity and HIV health outcomes are linked through nutritional, mental health, and health behavior pathways.ObjectiveTo examine the effects of a multisectoral agriculture and livelihood intervention on HIV viral suppression and nutritional, mental health, and behavioral outcomes among HIV-positive adults prescribed antiretroviral therapy (ART).Design, Setting, and ParticipantsThis cluster randomized clinical trial was performed in 8 pairs of health facilities in Kenya. Participants were 18 years or older, living with HIV, and receiving ART for longer than 6 months; had moderate to severe food insecurity; and had access to arable land and surface water and/or shallow aquifers. Participants were followed up every 6 months for 24 months. Data were collected from June 23, 2016, to June 13, 2017, with follow-up completed by December 16, 2019. Data were analyzed from June 25 to August 31, 2020, using intention-to-treat and per-protocol methods.InterventionsA loan to purchase a human-powered irrigation pump, fertilizer, seeds, and pesticides combined with the provision of training in sustainable agriculture and financial literacy.Main Outcomes and MeasuresThe primary outcome was the relative change from baseline to the end of follow-up in viral load suppression (≤200 copies/mL) compared between study groups using difference-in-differences analyses. Secondary outcomes included clinic attendance, ART adherence, food insecurity, depression, self-confidence, and social support.ResultsA total of 720 participants were enrolled (396 women [55.0%]; mean [SD] age, 40.38 [9.12] years), including 366 in the intervention group and 354 in the control group. Retention included 677 (94.0%) at the 24-month visit. HIV viral suppression improved in both groups from baseline to end of follow-up from 314 of 366 (85.8%) to 327 of 344 (95.1%) in the intervention group and from 291 of 353 (82.4%) to 314 of 333 (94.3%) in the control group (P = .86). Food insecurity decreased more in the intervention than the control group (difference in linear trend, −3.54 [95% CI, −4.16 to −2.92]). Proportions of those with depression during the 24-month follow-up period declined more in the intervention group (from 169 of 365 [46.3%] to 36 of 344 [10.5%]) than the control group (106 of 354 [29.9%] to 41 of 333 [12.3%]; difference in trend, −0.83 [95% CI, −1.45 to −0.20]). Self-confidence improved more in the intervention than control group (difference in trend, −0.37 [95% CI, −0.59 to −0.15]; P = .001), as did social support (difference in trend, −3.63 [95% CI, −4.30 to −2.95]; P &lt; .001).Conclusions and RelevanceIn this cluster randomized trial, the multisectoral agricultural intervention led to demonstrable health and other benefits; however, it was not possible to detect additional effects of the intervention on HIV clinical indicators. Agricultural interventions that improve productivity and livelihoods hold promise as a way of addressing food insecurity and the underpinnings of poor health among people living with HIV in resource-limited settings.Trial RegistrationClinicalTrials.gov Identifier: NCT02815579

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Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

et al. 2022

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Introduction:Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods: We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. Results and discussion: We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions: Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.

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High levels of viral load monitoring and viral suppression under Treat All in Rwanda – a cross‐sectional study

Cited by 21 publications

References 19 publications

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

Effect of a Multisectoral Agricultural Intervention on HIV Health Outcomes Among Adults in Kenya

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

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