Measures of human immunodeficiency virus (HIV) community viral load and HIV incidence among people who inject drugs

Glasheen, Cristie; Johnson, Eric O.; Lorvick, Jennifer; Kral, Alex H.

doi:10.1016/j.annepidem.2017.10.015

Cited by 2 publications

(2 citation statements)

References 32 publications

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“…Kelley and colleagues first proposed the concept of using PDV in a study of men who have sex with men in the United States to capture transmission risk and inequalities in healthcare coverage [ 21 ]. This measure was used in high‐prevalence areas to identify transmission hotspots [ 22 ] and within key population networks [ 23 , 24 ]. Two studies demonstrated its superiority over other metrics to predict HIV incidence [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Community‐ and individual‐level correlates of HIV incidence in HPTN 071 (PopART)

Skalland,

Ayles,

Bock

et al. 2023

J Int AIDS Soc.

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IntroductionUniversal HIV testing and treatment aims to identify all people living with HIV and offer them treatment, decreasing the number of individuals with unsuppressed HIV and thus reducing HIV transmission. Longitudinal follow‐up of individuals with and without HIV in a cluster‐randomized trial of communities allowed for the examination of community‐ and individual‐level measures of HIV risk and HIV incidence.MethodsHPTN 071 (PopART) was a three‐arm cluster‐randomized trial conducted between 2013 and 2018 that evaluated the use of two combination HIV prevention strategies implemented at the community level to reduce HIV incidence compared to the standard of care. The trial, conducted in 21 communities in Zambia and South Africa, measured HIV incidence over 36 months in a population cohort of ∼2000 randomly selected adults per community aged 18–44. Multilevel models were used to assess the association between HIV incidence and community‐ and individual‐level socio‐demographic and behavioural risk factors, as well as prevalence of detectable virus (PDV) defined as the estimated proportion of the community with unsuppressed viral load.ResultsOverall HIV incidence was 1.49/100 person‐years. Communities with less financial wealth and communities with more individuals reporting having sex partners outside of the community or two or more sexual partners had higher HIV incidence. PDV at 2 years of study was 6.8% and was strongly associated with HIV incidence: for every 50% relative reduction in community PDV, there was a 49% (95% confidence interval [CI]: 37%–58%, p < 0.001) relative decrease in HIV incidence. At the individual level; socio‐economic status, AUDIT score, medical male circumcision and certain sexual behaviours were associated with HIV risk.ConclusionsUsing data from the PopART randomized trial, we found several associations of HIV incidence with community‐level measures reflecting the sexual behaviour and socio‐economic make‐up of each community. We also found a strong association between community PDV and HIV incidence supporting the use of PDV as a tool for monitoring progress in controlling the epidemic. Lastly, we found significant individual‐level factors of HIV risk that are generally consistent with previous HIV epidemiological research. These results have the potential to identify high high‐incidence communities, inform structural‐level interventions, and optimize individual‐level interventions for HIV prevention.Clinical Trial NumberClinicalTrials.gov number, NCT01900977, HPTN 071 [PopArt]

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Section: Discussionmentioning

confidence: 99%

Community‐ and individual‐level correlates of HIV incidence in HPTN 071 (PopART)

Skalland,

Ayles,

Bock

et al. 2023

J Int AIDS Soc.

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“…A Colombian study [18] showed a strong correlation between increases in ART coverage, decreases in VL at the population level, and decreases in the number of new HIV cases. A study of injecting drug users in San Francisco showed that mean CVL was signi cantly associated with HIV incidence [19], validating the utility of CVLs as a measure of HIV transmission potential. To date, few studies in China have directly compared the level of VL surveillance among different populations in the same sample and analyzed the strength of associations between PVL surrogate measures and indicators related to HIV transmission potential.…”

Section: Introductionmentioning

confidence: 93%

Categorical testing of the viral load of people living with HIV to measure the intensity of the epidemic and the effectiveness of the response in the community: a prospective cohort study in Xinjiang China

He,

Ni,

et al. 2024

Preprint

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Background: New indicators of HIV transmission potential are being actively explored. We aim to categorical testing of the viral load of people living with HIV in order to explore new indicators to measure the intensity of the epidemic and the effectiveness of the response in the community. Methods: A dynamic cohort study was conducted in Yining to monitor the viral load (VL) of all individuals with HIV/AIDS from 2017 to 2019. Different PVL surrogate values were calculated and the strength of the associations between different PVL surrogates and HIV new incidence, antiretroviral therapy (ART) coverage, virus unsuppression, and viremia prevalence was assessed. Then we used PVL surrogate markers to describe the current status of HIV transmission potential in different characteristic populations and different communities. Results: All the values of different PVL indicators showed a decreasing trend year by year (P < 0.05). A significant correlation was observed between the decrease in community viral load (CVL) alone and the increase in the incidence of new HIV infections. Mean CVL (r = 1.000, P = 0.006), geometric mean CVL (r = 1.000, P = 0.001) were positively associated with HIV new infection. Both before and after imputation with missing values showed that mean CVL and geometric mean CVL were significantly associated with ART coverage and viral unsuppression (P < 0.05). Relatively high CVLs were found for males, ≤25 years of age, elementary school or less, other place of domicile, other type of health insurance, other source of sample, nonmarital noncommercial heterosexual contact, and nonmarital commercial heterosexual contact in the different characteristics groups. Community-based cross-sectional analyses showed a positive correlation between CVL, Viral unsuppression rate, and Viremia prevalence, and a negative correlation between ART coverage rate and the first three indicators, suggesting that “community 10” is the hotspot for HIV epidemics in the city. Conclusions: CVL can be used as an indicator evaluate the HIV transmission potential. To further reduce the HIV transmission potential, targeted interventions should be developed on key populations and hotspot communities.

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Measures of human immunodeficiency virus (HIV) community viral load and HIV incidence among people who inject drugs

Abstract: The effect of community VL on HIV incidence may be stronger than previously reported. Future studies of community VL surveillance should consider accounting for the prevalence of HIV using a prevalence-adjusted community VL measure.

Cited by 2 publications

References 32 publications

Community‐ and individual‐level correlates of HIV incidence in HPTN 071 (PopART)

Community‐ and individual‐level correlates of HIV incidence in HPTN 071 (PopART)

Categorical testing of the viral load of people living with HIV to measure the intensity of the epidemic and the effectiveness of the response in the community: a prospective cohort study in Xinjiang China

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