학술논문
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.
Document Type
Academic Journal
Author
Edun O; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.; Okell L; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.; Chun H; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Bissek AZ; Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon.; Ndongmo CB; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Yaoundé, Cameroon.; Shang JD; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Yaoundé, Cameroon.; Brou H; ICAP, Columbia University, Abidjan, Côte d'Ivoire.; Ehui E; National AIDS Control Programme, Ministry of Health, Public Hygiene and Universal Health Coverage, Abidjan, Côte d'Ivoire.; Ekra AK; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abidjan, Côte d'Ivoire.; Nuwagaba-Biribonwoha H; ICAP at Columbia University and Department of Epidemiology, Mailman School of Public Health, Mbabane, Eswatini.; Dlamini SS; Ministry of Health, Mbabane, Eswatini.; Ginindza C; Central Statistical Office, Mbabane, Eswatini.; Eshetu F; U.S. Centers for Disease Control and Prevention Division of Global HIV/TB, Center for Global Health, Addis Ababa, Ethiopia.; Misganie YG; Ethiopian Public Health Institute, HIV/AIDS and TB Research Directorate, Addis Ababa, Ethiopia.; School of Medicine, Zhejiang University, Hangzhou, China.; Desta SL; ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia.; Achia TNO; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Nairobi, Kenya.; Aoko A; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Nairobi, Kenya.; Jonnalagadda S; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Nairobi, Kenya.; Wafula R; National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya.; Asiimwe FM; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Maseru, Lesotho.; Lecher S; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Maseru, Lesotho.; Nkanaunena K; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Lilongwe, Malawi.; Nyangulu MK; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Lilongwe, Malawi.; Nyirenda R; Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi.; Beukes A; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Windhoek, Namibia.; Klemens JO; Namibia Institute of Pathology Limited, Windhoek, Namibia.; Taffa N; Ministry of Health and Social Services, Windhoek, Namibia.; Abutu AA; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abuja, Nigeria.; Alagi M; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abuja, Nigeria.; Charurat ME; Center for International Health, Education, and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, Maryland, United States of America.; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America.; Dalhatu I; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abuja, Nigeria.; Aliyu G; National Agency for the Control of AIDS, Abuja, Nigeria.; Kamanzi C; ICAP, Columbia University, Kigali, Rwanda.; Nyagatare C; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Kigali, Rwanda.; Rwibasira GN; HIV, STIs, Viral Hepatitis & OVDC Department, Rwanda Biomedical Center, Kigali, Rwanda.; Jalloh MF; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Dar es Salaam, Tanzania.; Maokola WM; National AIDS Control Programme, Tanzania Ministry of Health, Dar es Salaam, Tanzania.; Mgomella GS; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Dar es Salaam, Tanzania.; Kirungi WL; Ministry of Health, AIDS Control Programme, Kampala, Uganda.; Mwangi C; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Kampala, Uganda.; Nel JA; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Kampala, Uganda.; Minchella PA; U.S. Centers for Disease Control and Prevention Division of Global HIV/TB, Center for Global Health, Lusaka, Zambia.; Gonese G; Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH), Harare, Zimbabwe.; Nasr MA; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Harare, Zimbabwe.; Public Health Institute, Global Health Fellowship Program, United States of America.; Bodika S; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Mungai E; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; eTeam, Somerset, New Jersey, United States of America.; Patel HK; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Sleeman K; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Milligan K; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Peraton, Herndon, Virginia, United States of America.; Dirlikov E; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Voetsch AC; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Shiraishi RW; U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America.; Imai-Eaton JW; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom.; Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Source
Publisher: Public Library of Science Country of Publication: United States NLM ID: 9918283779606676 Publication Model: eCollection Cited Medium: Internet ISSN: 2767-3375 (Electronic) Linking ISSN: 27673375 NLM ISO Abbreviation: PLOS Glob Public Health Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
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.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jeffrey W. Imai-Eaton has received grants/contracts from NIH and WHO, consulting fees from BAO Systems, support for attending meetings from UNAIDS, SACEMA and the International AIDS Society and is a member of the editorial board for PLOS Global Public Health. Olanrewaju Edun has received consulting fees from University of Cape Town and WHO and support for attending meetings from UNAIDS. All other authors have declared that no competing interests exist.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jeffrey W. Imai-Eaton has received grants/contracts from NIH and WHO, consulting fees from BAO Systems, support for attending meetings from UNAIDS, SACEMA and the International AIDS Society and is a member of the editorial board for PLOS Global Public Health. Olanrewaju Edun has received consulting fees from University of Cape Town and WHO and support for attending meetings from UNAIDS. All other authors have declared that no competing interests exist.
(Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)