Spatiotemporal Variation and Predictors of Unsuppressed Viral Load among HIV-Positive Men and Women in Rural and Peri-Urban KwaZulu-Natal, South Africa

Abstract

Unsuppressed HIV viral load is an important marker of sustained HIV transmission. We investigated the prevalence, predictors, and high-risk areas of unsuppressed HIV viral load among HIV-positive men and women. Unsuppressed HIV viral load was defined as viral load of ≥400 copies/mL. Data from the HIV Incidence District Surveillance System (HIPSS), a longitudinal study undertaken between June 2014 to June 2016 among men and women aged 15–49 years in rural and peri-urban KwaZulu-Natal, South Africa, were analysed. A Bayesian geoadditive regression model which includes a spatial effect for a small enumeration area was applied using an integrated nested Laplace approximation (INLA) function while accounting for unobserved factors, non-linear effects of selected continuous variables, and spatial autocorrelation. The prevalence of unsuppressed HIV viral load was 46.1% [95% CI: 44.3–47.8]. Predictors of unsuppressed HIV viral load were incomplete high school education, being away from home for more than a month, alcohol consumption, no prior knowledge of HIV status, not ever tested for HIV, not on antiretroviral therapy (ART), on tuberculosis (TB) medication, having two or more sexual partners in the last 12 months, and having a CD4 cell count of <350 cells/μL. A positive non-linear effect of age, household size, and the number of lifetime HIV tests was identified. The higher-risk pattern of unsuppressed HIV viral load occurred in the northwest and northeast of the study area. Identifying predictors of unsuppressed viral load in a localized geographic area and information from spatial risk maps are important for targeted prevention and treatment programs to reduce the transmission of HIV.

Viral suppression and associated factors among children tested for HIV viral load at Amhara Public Health Institute, Dessie Branch, Ethiopia: a cross-sectional study

“…The proportion of HIV-positive adolescents on antiretroviral therapy (ART) who were not virologically suppressed after 6 months was 23% in South Africa. WHO stage IV and ART-related facial outcomes were strongly associated with virological non-suppression, whereas an earlier age of onset of 5 years or more was considered protective compared with WHO stage I 2. In Eswatini, HIV-positive children on ART and on antiretroviral drug regimen experienced viral suppression at a rate of 77.9%, with NVP-based ART having the lowest rates 3.…”

“…WHO stage IV and ART-related facial outcomes were strongly associated with virological non-suppression, whereas an earlier age of onset of 5 years or more was considered protective compared with WHO stage I. 2 In Eswatini, HIV-positive children on ART and on antiretroviral drug regimen experienced viral suppression at a rate of 77.9%, with NVP-based ART having the lowest rates. 3 After 1–5 years on highly active ART (HAART), more than half of Nigerian children receiving HAART had a viral load above 1000 copies/mL.…”

Geospatial and temporal mapping of detectable HIV-1 viral loads amid dolutegravir rollout in KwaZulu-Natal, South Africa

“…Although the UNAIDS 95-95-95 strategy aims at ensuring that 95% of all people living with HIV (PLWH) are diagnosed, 95% of all PLWH diagnosed receive antiretroviral therapy (ART), and 95% of people on ART achieve sustained viral suppression, South Africa is still lagging behind in achieving these targets [ 1 – 4 ]. In KwaZulu-Natal (KZN), the province with the greatest burden of HIV in South Africa [ 5 , 6 ], there are HIV-hyperendemic areas where sustained viral suppression among PLWH is substantially lower (53.9%) than the UNAIDS target [ 7 ]. Studies have shown that population prevalence of detectable viraemia could infer the effectiveness of HIV treatment programmes as well as community HIV risk potential [ 8 – 10 ].…”