Level of viral suppression and the cascade of HIV care in a South African semi-urban setting in 2012

Jean, Kévin; Puren, Adrian; Cutler, Ewalde; Singh, Beverley; Bouscaillou, Julie; Rain-Taljaard, Reathe; Taljaard, Dirk; Gouws, Eleanor; Lissouba, Pascale; Lewis, David A.; Peytavin, Gilles; Auvert, Bertran

doi:10.1097/qad.0000000000001155

Cited by 14 publications

(25 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Findings specifically support those of earlier studies that identified alcohol use as a risk factor for lower engagement in HIV care, 21–23,27,60 treatment with ART 24,25,27 and viral suppression. 26,27 Moreover, this study newly demonstrated a dose-dependent association between alcohol use and three HIV care continuum outcomes such that PLWH reporting alcohol use at medium, high, and very high levels had progressively lower likelihood of all care continuum outcomes relative to patients who reported non-drinking.…”

Section: Discussionsupporting

confidence: 85%

“…In the U.S., 54% of PLWH report any alcohol use and 25% report any heavy episodic drinking, an unhealthy pattern of use known to adversely influence multiple health outcomes. 13 Alcohol use is associated with HIV care including: testing 14–16 and diagnosis; 17 care engagement, 18 quality, 19 and retention; 20–23 receipt and use of ART; 24,25 and potentially viral suppression. 26–28 Thus, alcohol use may represent a modifiable influence on HIV care continuum targets.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

et al. 2018

View full text Add to dashboard Cite

We evaluated associations between levels of alcohol use and HIV care continuum components using national Veterans Aging Cohort Study data for all patients with HIV and AUDIT-C screening (2/1/2008-9/30/2014). Poisson regression models evaluated associations between alcohol use levels (non-drinking, low-, medium-, high-, and very high-level drinking) and: (1) engagement with care (documented CD4 cells/µl or viral load copies/ml labs), (2) ART treatment (≥ 1 prescription), and (3) viral suppression (HIV RNA < 500 copies/ml) within one year. Among 33,224 patients, alcohol use level was inversely associated with all care continuum outcomes (all p < 0.001). Adjusted prevalence of care engagement ranged from 77.8% (95% CI 77.1-78.4%) for non-drinking to 69.1% (66.6-71.6%) for high-level drinking. The corresponding range for ART treatment was 74.0% (73.3-74.7%) to 60.1% (57.3-62.9%) and for viral suppression was 57.3% (56.5-58.1%) to 38.3% (35.6-41.1%). Greater alcohol use is associated with suboptimal HIV treatment across the HIV care continuum.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Under the constant effort scenario we assume that 90% of people on ART are virally suppressed based on a study carried out in South Africa. 11 Under the expanded treatment and prevention scenario we assume that 96.5% of people on ART are virally suppressed based on a study carried out in Botswana. 12 We assume that the infectiousness of those that are not virally suppressed is 12% of the infectiousness of people that are not on ART (see Appendix 1).…”

Section: Data Sources and Assumptionsmentioning

confidence: 99%

“…Each of these proportions is multiplied by an overall rate at which people start treatment. We assume that 92% of people on ART are virally suppressed 11 and that the infectiousness of those that are not virally suppressed is 12% of the infectiousness of people that are not on ART (see Appendix 1). Rates are all per adult aged 15 years or more.…”

Section: Data Sources and Assumptionsmentioning

confidence: 99%

Ending AIDS: Progress and prospects for the control of HIV and TB in South Africa

Williams¹,

Gupta

Wollmers

et al. 2016

Preprint

View full text Add to dashboard Cite

We use a dynamical model to fit data on time trends in HIV prevalence and anti-retroviral treatment (ART) coverage for adults in South Africa. We estimate current and project future trends in HIV incidence, prevalence and AIDS related deaths; in ART coverage and incidence; and in TB notification rates. We consider two scenarios: constant effort under which people continue to be started on treatment at the current rate and expanded treatment and prevention under which testing rates are increased, everyone is started on treatment as soon as they are found to be infected with HIV, and voluntary medical male circumcision, pre-exposure prophylaxis and condom distribution programmes are expanded.HIV incidence and mortality are falling as a result of the expansion of treatment: between 2010 and 2016 incidence fell by 65% and AIDS related deaths fell by 80%. Maintaining a policy of constant effort will lead to further declines in HIV incidence, AIDS related mortality and TB notification rates but will not end AIDS. Implementing a policy of expanded treatment and prevention, as the South African Government intends to do in September 2016, should ensure that by 2020 new infections and deaths will be less than one per thousand adults and the UNAIDS Goal of Ending AIDS by 2030 will be reached. Scaling up voluntary medical male circumcision, pre-exposure prophylaxis and condoms availability will avert some new infections but will save relatively few lives although equity demands that people at very high risk of infection including commercial sex-workers, men-who-have-sex-with-men and young women should have access to the best available methods of prevention.Managing HIV and TB currently costs South Africa about US$2.2 Bn (0.47% of GDP) and this will rise to a peak of US$2.8 Bn in 2018 (0.55% GDP). As treatment is scaled up and prevention made available to those at high risk, the cost will fall to US$ 1.8 Bn in 2030 and US$ 1.0 Bn in 2050 as those that are living with HIV but are on ART die of natural causes. The cost of testing people for HIV is never more than about 8% of the total cost and since testing is the sine qua non of treatment it will be essential to invest sufficient resources in testing. The cost of treating tuberculosis is never more than about 10% of the total and since this is the major cause of AIDS related illness and deaths, efforts should be made to optimise TB treatment.Ending AIDS in the world will depend critically on what happens in South Africa which accounts for 20% of all people living with HIV. The increasing availability of ART has had a major impact on both HIV incidence and AIDS related mortality and the cost of achieving this is affordable. With the intention to make treatment available to all those infected with HIV, starting in September 2016, the South African government is well placed to eliminate HIV as a major threat to public health by 2020 and end AIDS by 2030. Individuals at high risk of infection deserve access to the best available methods of protecting themselves and they will becom...

show abstract

“…Meeting the '90-90-90' targets requires an approximate population viral suppression rate among all PLWH, including those not in care, of approximately 73%. Most of the published work evaluating the '90-90-90' targets have relied on special surveys [7][8][9][10] or mathematical models [11,12], and when routine data are used, the results typically provide only a snapshot of the progress for a 1-year period [13,14].…”

Section: Main Text Introductionmentioning

confidence: 99%

Mixed method estimation of population level HIV viral suppression rate in the Western Cape, South Africa

Mukonda

Hsiao

Vojnov

et al. 2020

Preprint

View full text Add to dashboard Cite

Introduction There are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from ART programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates. Methods VL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test- and individual-level VS rates were based on test VL values <1000 cps/ml, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived mid-year population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data. Results Approximately 1.9 million VL test results between 2008 - 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed ART coverage and population HIV prevalence. Conclusion While validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.

show abstract

Level of viral suppression and the cascade of HIV care in a South African semi-urban setting in 2012

Cited by 14 publications

References 32 publications

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

Ending AIDS: Progress and prospects for the control of HIV and TB in South Africa

Mixed method estimation of population level HIV viral suppression rate in the Western Cape, South Africa

Contact Info

Product

Resources

About