Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage
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- Evaluated articles (Rapid Reviews Infectious Diseases)
Abstract
Introduction
To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which HIV viraemia is concentrating.
Methods
We analysed HIV testing and viral load data collected between 2013-2019 from the open, population-based Rakai Community Cohort Study (RCCS) in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, one-year age bands and residence in inland and fishing communities. All estimates were standardized to the underlying source population using census data. We then assessed 95-95-95 targets in their ability to identify the populations in which viraemia concentrates.
Results
Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%-5.3%) in 2013 to 1.9% (1.7%-2.2%) in 2019 in inland communities and from 19.1% (18.0%-20.4%) in 2013 to 4.7% (4.0%-5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95-95-95 targets. Instead, in both inland and fishing communities, women aged 25-29 and men aged 30-34 were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or had already achieved 95-95-95 targets.
Conclusions
The 95-95-95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.
Article activity feed
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Gabriel Chamie
Review 2: "Age and Gender Profiles of HIV Infection Burden and Viraemia: Novel Metrics for HIV Epidemic Control in African Populations with High Antiretroviral Therapy Coverage"
The reviewers commend the study for its comprehensive analysis of HIV prevalence and viremia in Ugandan communities, emphasizing that the UNAIDS 95-95-95 targets alone are insufficient to understand and address HIV transmission risks fully.
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Wolfgang Hladik
Review 1: "Age and Gender Profiles of HIV Infection Burden and Viraemia: Novel Metrics for HIV Epidemic Control in African Populations with High Antiretroviral Therapy Coverage"
The reviewers commend the study for its comprehensive analysis of HIV prevalence and viremia in Ugandan communities, emphasizing that the UNAIDS 95-95-95 targets alone are insufficient to understand and address HIV transmission risks fully.
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Strength of evidence
Reviewers: W Hladik (CDC) | 📘📘📘📘📘
G Chamie (UCSF) | 📘📘📘📘📘 -
