2IUM5WB3
type: UserItem
resource: Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa
repository: PubMed
rights: All rights reserved

Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa
type: AcademicArticle
abstract: Universal HIV testing and treatment (UTT) strategies aim to optimize population-level benefits of antiretroviral treatment. Between 2012 and 2018, four large community randomized trials were conducted in eastern and southern Africa. While their results were broadly consistent showing decreased population-level viremia reduces HIV incidence, it remains unclear how much HIV incidence can be reduced by increasing suppression among people living with HIV (PLHIV). We conducted a pooled analysis across the four UTT trials. Leveraging data from 105 communities in five countries, we evaluated the linear relationship between i) population-level viremia (prevalence of non-suppression-defined as plasma HIV RNA >500 or >400 copies/mL-among all adults, irrespective of HIV status) and HIV incidence; and ii) prevalence of non-suppression among PLHIV and HIV incidence, using parametric g-computation. HIV prevalence, measured in 257 929 persons, varied from 2 to 41% across the communities; prevalence of non-suppression among PLHIV, measured in 31 377 persons, from 3 to 70%; population-level viremia, derived from HIV prevalence and non-suppression, from < 1% to 25%; and HIV incidence, measured over 345 844 person-years (PY), from 0.03/100PY to 3.46/100PY. Decreases in population-level viremia were strongly associated with decreased HIV incidence in all trials (between 0.45/100PY and 1.88/100PY decline in HIV incidence per 10 percentage points decline in viremia). Decreases in non-suppression among PLHIV were also associated with decreased HIV incidence in all trials (between 0.06/100PY and 0.17/100PY decline in HIV incidence per 10 percentage points decline in non-suppression). Our results support both the utility of population-level viremia as a predictor of incidence, and thus a tool for targeting prevention interventions, and the ability of UTT approaches to reduce HIV incidence by increasing viral suppression. Implementation of universal HIV testing approaches, coupled with inter…
pages: e0002157
doi: 10.1371/journal.pgph.0002157
PMID: 37450436
PMCID: PMC10348573
language: eng
creator: Person
author list: Person
author list: UT³C consortium
creator: UT³C consortium
is part of: Issue
  date: 2023
  volume: 3
  issue: 7
  is part of: PLOS global public health
    type: Journal
    short title: PLOS Glob Public Health
    issn: 2767-3375

Person
given name: Joseph
surname: Larmarange

Person
given name: Pamela
surname: Bachanas

Person
given name: Timothy
surname: Skalland

Person
given name: Laura B.
surname: Balzer

Person
given name: Collins
surname: Iwuji

Person
given name: Sian
surname: Floyd

Person
given name: Lisa A.
surname: Mills

Person
given name: Deenan
surname: Pillay

Person
given name: Diane
surname: Havlir

Person
given name: Moses R.
surname: Kamya

Person
given name: Helen
surname: Ayles

Person
given name: Kathleen
surname: Wirth

Person
given name: François
surname: Dabis

Person
given name: Richard
surname: Hayes

Person
given name: Maya
surname: Petersen

UT³C consortium
type: Organization