National HIV Care Continua for Key Populations

Gupta, Somya; Granich, Reuben

doi:10.1177/2325957416686195

Cited by 33 publications

(39 citation statements)

References 16 publications

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“…Specifically, without patient identifiers and a cohort system, patient loss after diagnosis, duplication of patients in the system, and lack of individually linked viral load results may compromise the validity of some continua. Also, this study did not evaluate the availability of high-burden subnational or population-specific care continuums (e.g., key populations), which may more directly inform strategies for targeted program improvement and community incidence interruption [39]. …”

Section: Discussionmentioning

confidence: 99%

“…As part of this effort, it will be important to clearly define and describe standard numerators and denominators so that “diagnosed HIV,” “receiving ART,” “on ART,” and “viral suppression” have the same meaning regardless of national setting. Additionally, continuum for patients with HIV-associated tuberculosis, pregnant women, youth, and key populations may also prove to be useful [39]. While accurate program data are essential to monitor service delivery and progress, routine case-based surveillance can also be considered as a tool to monitor generalized HIV epidemics or infections in key populations as well as to promote linkage to care [40].…”

Section: Discussionmentioning

confidence: 99%

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Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review

et al. 2017

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BackgroundIn 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target.Methods and findingsFor the period 2010–2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President’s Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010–2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for “on ART” and for “viral suppression,” respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain.ConclusionsRelatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review

et al. 2017

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“…However, MSM and FSW surveys in Mozambique reported lower awareness of their HIV status compared to those same groups in other Sub-Saharan African countries, although PWID participants reported higher awareness than other PWID in the region (11)(12)(13)(14)(15). ART engagement was also lower across all populations groups (11,(15)(16)(17). In the few studies with results of viral load suppression in Sub-Saharan Africa, there was a range of 11%-42 among MSM, 11.0%-49.5% among FSW and less than 5% in among PWID in Kenya.…”

Section: Discussionmentioning

confidence: 91%

Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

Boothe

Sathane²,

Baltazar

et al. 2020

Preprint

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Background. Mozambique has a generalized HIV epidemic of 13.5% among the general population. Early modeling exercises estimate that key populations (KPs) and their partners account for about one third of all new infections due to their sexual and drug use behaviors. The Fast Track Targets monitor key indicators along the treatment cascade. Methods. We conducted a secondary data analysis of HIV-positive participants in the first Bio-behavioral Surveillance (BBS) surveys in Mozambique in order to assess HIV service uptake and progress though the HIV treatment cascade among men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID). Unweighted pooled estimates were calculated for each key population group. Results. Among HIV-positive MSM, 63.2% of participants had ever received an HIV test, 8.8% were aware of their status, 6.1% reported having been linked to care, while 3.5% initiated ART and were currently on treatment. Of the HIV-infected FSW participants, 76.5% reported a previous HIV test and 22.4% were previously aware of their status. Linkage to care was reported by 20.1%, while 12.7% reported having initiated ART and 11.8% reported being on treatment at the time of the survey. Among HIV-infected PWID participants, 79.9% had previously received an HIV test, 63.2% were aware of their HIV status, and 49.0% reported being linked to care for their HIV infection. ART initiation was reported by 42.7% of participants, while 29.4% were on ART at the time of the survey. All key population groups fell below the global targets of the HIV treatment cascade. Conclusion. Among the three high risk populations in Mozambique, losses occurred throughout critical areas of service uptake with the most alarming breakpoint occurring at knowledge of HIV status. Special attention should be given to increasing HIV testing and linkage to ART treatment. Future surveys will provide the opportunity to monitor improvements across the cascade and should include viral load testing to guarantee a more complete picture of the treatment cascade.

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“…Figure 3 presents the median ART coverage and the 100% percentile for 30 simulations with the scenarios STI-nBC, nSTI-BC and STI-BC. We observe that the scenario nSTI-BC has the closest approximation of the value of 62% ART coverage in 2013 [15] . Figure 4 shows that none of the scenarios including an STI and/or increased risk behaviour explains the 95 increasing trend in HIV SPVL between 1995 and 2007 described by Gras et al [14].…”

Section: /14mentioning

confidence: 85%

Influence of sexual risk behaviour and STI co-infection dynamics on the evolution of HIV set point viral load in MSM

Hendrickx

Delva

Hens

2019

Preprint

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HIV set-point viral load (SPVL) is an important predictor of HIV progression and transmission. Although it has been reported that anti-retroviral therapy (ART) reduces viral load (VL), increased SPVL levels have been observed in MSM in the decade following the introduction of ART in the Netherlands. Several studies have been devoted to explain these counter-intuitive trends in SPVL. However, to our knowledge, none of these studies has investigated an explanation in which it arises as the result of a sexually transmitted infection (STI) co-factor in detail. In this study, we adapted an event-based, individual-based model to investigate how STI co-infection and sexual risk behaviour affect the evolution of HIV SPVL in MSM before and after the introduction of ART. The results suggest that both STI co-factors and sexual risk behaviour have an effect on SPVL. However, the observed trends in SPVL cannot be explained by sexual risk behaviour and STI co-factors only. We recommend to develop mathematical models including also factors related to viral evolution as reported earlier in the literature. However, this requires more complex models, and the collection of more data for parameter estimation than what is currently available.

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National HIV Care Continua for Key Populations

Cited by 33 publications

References 16 publications

Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review

Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review

Low Engagement in HIV Services and Progress through the Treatment Cascade among Key Populations Living with HIV in Mozambique: Alarming Gaps in Knowledge of Status

Influence of sexual risk behaviour and STI co-infection dynamics on the evolution of HIV set point viral load in MSM

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