HIV risk behaviour, viraemia, and transmission across HIV cascade stages including low-level viremia: Analysis of 14 cross-sectional population-based HIV Impact Assessment surveys in sub-Saharan Africa

被引：1

作者：

Edun, Olanrewaju ^{[1
]}

Okell, Lucy ^{[1
]}

Chun, Helen ^{[2
]}

Bissek, Anne-Cecile Z. ^{[3
,4
]}

Ndongmo, Clement B. ^{[5
]}

Shang, Judith D. ^{[5
]}

Brou, Hermann ^{[6
]}

Ehui, Eboi ^{[7
]}

Ekra, Alexandre K. ^{[8
]}

Nuwagaba-Biribonwoha, Harriet ^{[9
,10
]}

Dlamini, Sindisiwe S. ^{[11
]}

Ginindza, Choice ^{[12
]}

Eshetu, Frehywot ^{[13
]}

Misganie, Yimam G. ^{[14
,15
]}

Desta, Sileshi Lulseged ^{[16
]}

Achia, Thomas N. O. ^{[17
]}

Aoko, Appolonia ^{[17
]}

Jonnalagadda, Sasi ^{[17
]}

Wafula, Rose ^{[18
]}

Asiimwe, Fred M. ^{[19
]}

Lecher, Shirley ^{[19
]}

Nkanaunena, Kondwani ^{[20
]}

Nyangulu, Mtemwa K. ^{[20
]}

Nyirenda, Rose ^{[21
]}

Beukes, Anita ^{[22
]}

Klemens, Johannes O. ^{[23
]}

Taffa, Negussie ^{[24
]}

Abutu, Andrew A. ^{[25
]}

Alagi, Matthias ^{[25
]}

Charurat, Man E. ^{[26
,27
]}

Dalhatu, Ibrahim ^{[25
]}

Aliyu, Gambo ^{[28
]}

Kamanzi, Collins ^{[29
]}

Nyagatare, Celestine ^{[30
]}

Rwibasira, Gallican N. ^{[31
]}

Jalloh, Mohamed F. ^{[32
]}

Maokola, Werner M. ^{[33
]}

Mgomella, George S. ^{[32
]}

Kirungi, Wilford L. ^{[34
]}

Mwangi, Christina ^{[35
]}

Nel, Jennifer A. ^{[35
]}

Minchella, Peter A. ^{[36
]}

Gonese, Gloria ^{[37
]}

Nasr, Melodie A. ^{[38
,39
]}

Bodika, Stephane ^{[2
]}

Mungai, Elisabeth ^{[2
,40
]}

Patel, Hetal K. ^{[2
]}

Sleeman, Katrina ^{[2
]}

Milligan, Kyle ^{[2
,41
]}

Dirlikov, Emilio ^{[2
]}

机构：

[1] Imperial Coll London, MRC Ctr Global Infect Dis Anal, Sch Publ Hlth, London, England

[2] US Ctr Dis Control & Prevent, Div Global HIV & TB, Ctr Global Hlth, Atlanta, GA USA

[3] Minist Publ Hlth, Div Hlth Operat Res, Yaounde, Cameroon

[4] Univ Ngaoundere, Fac Med & Biomed Sci, Garoua, Cameroon

[5] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Yaounde, Cameroon

[6] Columbia Univ, ICAP, Abidjan, Cote Ivoire

[7] Minist Hlth Publ Hyg & Universal Hlth Coverage, Natl AIDS Control Programme, Abidjan, Cote Ivoire

[8] US Ctr Dis Control & Prevent, Div Global HIV & TB, Ctr Global Hlth, Abidjan, Cote Ivoire

[9] Columbia Univ, ICAP, Mbabane, Eswatini

[10] Mailman Sch Publ Hlth, Dept Epidemiol, Mbabane, Eswatini

[11] Minist Hlth, Mbabane, Eswatini

[12] Cent Stat Off, Mbabane, Eswatini

[13] US Ctr Dis Control & Prevent, Div Global HIV TB, Ctr Global Hlth, Addis Ababa, Ethiopia

[14] Ethiopian Publ Hlth Inst, HIV AIDS & TB Res Directorate, Addis Ababa, Ethiopia

[15] Zhejiang Univ, Sch Med, Hangzhou, Peoples R China

[16] Columbia Univ, Mailman Sch Publ Hlth, ICAP Ethiopia, Addis Ababa, Ethiopia

[17] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Nairobi, Kenya

[18] Minist Hlth, Natl AIDS & STI Control Programme, Nairobi, Kenya

[19] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Maseru, Lesotho

[20] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Lilongwe, Malawi

[21] Minist Hlth, Dept HIV AIDS, Lilongwe, Malawi

[22] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Windhoek, Namibia

[23] Namibia Inst Pathol Ltd, Windhoek, Namibia

[24] Minist Hlth & Social Serv, Windhoek, Namibia

[25] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Abuja, Nigeria

[26] Univ Maryland, Sch Med, Ctr Int Hlth Educ & Biosecur Ciheb, Baltimore, MD USA

[27] Univ Maryland, Sch Med, Inst Human Virol, Baltimore, MD USA

[28] Fed Minist Environm, Abuja, Nigeria

[29] Columbia Univ, ICAP, Kigali, Rwanda

[30] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Kigali, Rwanda

[31] Rwanda Biomed Ctr, HIV STIs Viral Hepatitis & OVDC Dept, Kigali, Rwanda

[32] US Ctr Dis Control & Prevent, Div Global HIV TB, Ctr Global Hlth, Dar Es Salaam, Tanzania

[33] Tanzania Minist Hlth, Natl AIDS Control Programme, Dar Es Salaam, Tanzania

[34] Minist Hlth, AIDS Control Programme, Kampala, Uganda

[35] US Ctr Dis Control & Prevent, Div Global HIV TB, Ctr Global Hlth, Kampala, Uganda

[36] US Ctr Dis Control & Prevent, Ctr Global Hlth, Div Global HIV TB, Lusaka, Zambia

[37] Zimbabwe Tech Assistance Training & Educ Ctr Hlth, Harare, Zimbabwe

[38] US Ctr Dis Control & Prevent, Div Global HIV TB, Ctr Global Hlth, Harare, Zimbabwe

[39] CDC, Publ Hlth Inst, Washington, DC USA

[40] eTeam, Somerset, NJ USA

[41] Peraton, Herndon, VA USA

[42] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Ctr Communicable Dis Dynam, Boston, MA USA

来源：

PLOS GLOBAL PUBLIC HEALTH | 2024年 / 4卷 / 04期

基金：

英国医学研究理事会; 比尔及梅琳达.盖茨基金会; 英国惠康基金;

关键词：

VIRAL LOAD; HETEROSEXUAL TRANSMISSION; DETERMINANTS; ZIMBABWE; QUALITY; CARE;

D O I：

10.1371/journal.pgph.0003030

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

As antiretroviral treatment (ART) coverage for people living with HIV (PLHIV) increases, HIV programmes require up-to-date information about evolving HIV risk behaviour and transmission risk, including those with low-level viremia (LLV; >50 to <1000 copies/mL), to guide prevention priorities. We aimed to assess differences in sexual risk behaviours, distribution of viral load (VL) and proportion of transmission across PLHIV subgroups. We analysed data from Population-based HIV Impact Assessment surveys in 14 sub-Saharan African countries during 2015-2019. We estimated adjusted prevalence ratios (aPR) of self- reported HIV high-risk behaviour (multiple partners and condomless sex) across cascade stages via generalised estimation equations. We modelled the proportions of transmission from each subgroup using relative self-reported sexual risk, a Hill function for transmission rate by VL, and proportions within cascade stages from surveys and UNAIDS country estimates for 2010-2020. Compared to PLHIV with undetectable VL (<50 copies/mL), undiagnosed PLHIV (aPR women: 1.28 [95% CI: 1.08-1.52]; men: 1.61 [1.33-1.95]) and men diagnosed but untreated (2.06 [1.52-2.78]) were more likely to self-report high-risk sex. High-risk behaviour was not significantly associated with LLV. Mean VL was similar among undiagnosed, diagnosed but untreated, and on ART but non-suppressed sub-groups. Across surveys, undiagnosed and diagnosed but untreated contributed most to transmission (40-91% and 1-41%, respectively), with less than 1% from those with LLV. Between 2010 and 2020, the proportion of transmission from individuals on ART but non-suppressed increased. In settings with high ART coverage, effective HIV testing, ART linkage, and retention remain priorities to reduce HIV transmission. Persons with LLV are an increasing share of PLHIV but their contribution to HIV transmission was small. Improving suppression among PLHIV on ART with VL >1000 copies/mL will become increasingly important.

引用

页数：21

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