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Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage
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March 2020
Source: AIDS. 34(4):631-636
[PDF-331.24 KB]
Details:
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Alternative Title:AIDS
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Personal Author:
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Description:Objective:
To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood.
Design:
Post hoc analysis of nationally-representative household survey to compare alternative biomarker-based adjustments to population HIV indicators.
Methods:
We reclassified HIV-positive participants aged 15–64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) that were unaware of their HIV-positive status by self-report as aware and on antiretroviral treatment if either ARVs were detected or viral load was undetectable (<550 copies/mL) on dried blood spots. We compared self-report to adjustments for ARVs measurement, UVL, or both.
Results:
Treatment coverage among all HIV-positive respondents increased from 31.8% for self-report to 42.5% [95% confidence interval (CI) 37.4–47.8] based on ARV detection alone, to 42.8% (95% CI 37.9–47.8) when ARV-adjusted, 46.2% (95% CI 41.3–51.1) when UVL-adjusted and 48.8% (95% CI 43.9–53.8) when adjusted for either ARV or UVL. Awareness of positive status increased from 46.9% for self-report to 56.2% (95% CI 50.7–61.6) when ARV-adjusted, 57.5% (95% CI 51.9–63.0) when UVL-adjusted, and 59.8% (95% CI 54.2–65.1) when adjusted for either ARV or UVL.
Conclusions:
Undetectable viral load, which is routinely measured in surveys, may be a useful adjunct or alternative to ARV detection for adjusting survey estimates of knowledge of HIV status and antiretroviral treatment coverage.
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Pubmed ID:31794520
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Pubmed Central ID:PMC8157159
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