The HIV cascade of care among serodiscordant couples in four high HIV prevalence settings in sub-Saharan Africa

被引：3

作者：

Chihana, M. L. ^{[1
,2
]}

Conan, N. ^{[2
]}

Ellman, T. ^{[3
]}

Poulet, E. ^{[4
]}

Garone, D. B. ^{[5
]}

Ortuno, R. ^{[6
]}

Wanjala, S. ^{[7
]}

Masiku, C. ^{[8
]}

Etard, J-F ^{[4
,9
]}

Davies, M-A ^{[1
]}

Maman, D. ^{[1
,8
]}

机构：

[1] Univ Cape Town, Fac Hlth Sci, Sch Publ Hlth & Family Med, Cape Town, South Africa

[2] Epicentre, Cape Town, South Africa

[3] Med Sans Frontieres, Southern Africa Med Unit SAMU, Cape Town, South Africa

[4] Epicentre, Paris, France

[5] Med Sans Frontieres, Brussels, Belgium

[6] Med Sans Frontieres, Blantyre, Malawi

[7] Med Sans Frontieres, Nairobi, Kenya

[8] Med Sans Frontieres, Lilongwe, Malawi

[9] Montpellier Univ, TransVIHMI, Montpellier, France

来源：

SAMJ SOUTH AFRICAN MEDICAL JOURNAL | 2021年 / 111卷 / 08期

基金：

新加坡国家研究基金会;

关键词：

ANTIRETROVIRAL THERAPY; VIRAL LOAD; RISK; TRANSMISSION; ACQUISITION; PREVENTION;

D O I：

10.7196/SAMJ.2021.v111i8.15489

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background. HIV-serodiscordant couples are at high risk of HIV transmission. In sub-Saharan Africa, HIV-serodiscordant couples contribute-30% of all new infections in the region. Objectives. To quantify the prevalence of HIV-serodiscordant couples and evaluate steps of the HIV cascade of care among people living with HIV in serodiscordant relationships in four high-prevalence settings in sub-Saharan Africa. Methods. Four HIV prevalence surveys were conducted: in Ndhiwa (Kenya) in 2012, in Chiradzulu (Malawi) in 2013, and in Gutu (Zimbabwe) and Nsanje (Malawi) in 2016. Eligible individuals aged 15 -59 years were asked to participate in voluntary rapid HIV testing. Viral load and CD4 counts were measured on those who tested HIV-positive. A couple was defined as a man and a woman who reported being married or cohabiting and were living together in the same household. Results. Among 4 385 couples, the prevalence of HIV serodiscordancy was 10.9% (95% confidence interval (CI) 10.2 -11.5) overall, ranging from 6.7% (95% CI 5.6 -7.9) in Nsanje to 15.8% (95% CI 14.5 -17.3) in Ndhiwa. Men were the HIV-positive partner in 62.7% of the serodiscordant couples in Ndhiwa, in 60.4% in Gutu, in 48.8% in Chiradzulu and in 50.9% in Nsanje. Status awareness among HIV-positive partners in serodiscordant couples ranged from 45.4% in Ndhiwa to 70.7% in Gutu. Viral load suppression (VLS) ranged from 33.9% in Ndhiwa to 68.5% in Nsanje. VLS was similar by sex in three settings, Ndhiwa (37.8% (men) v. 27.8% (women); p=0.16), Nsanje (60.7% v. 76.9%; p=0.21) and Gutu (48.2% v. 55.6%; p=0.63), and dissimilar by sex in Chiradzulu (44.4% v. 62.7%; p=0.03). Conclusions. Low HIV status awareness and poor VLS among HIV-positive partners are major gaps in preventing transmission among serodiscordant couples. Intensifying programmes that target couples to test for HIV and timely antiretroviral therapy initiation could increase VLS and reduce HIV transmission.

引用

页码：768 / 776

页数：9

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