J Acquir Immune Defic Syndr

Background: HIV-1 RNA load is the best biological predictor of HIV transmission and treatment response. The rate of virologic suppression among key sub-populations can guide HIV prevention programs. Methods: The Botswana Combination Prevention Project performed a population-based household survey among adults in 30 communities in Botswana. Data collected included knowledge of HIV-positive status, ART coverage and virologic suppression (HIV-1 RNA ≤400 copies/mL). Individuals aged 16–29 years were considered young adults. Results: Among 552 young people living with HIV (PLHIV) enrolled with RNA load data and ART status available, 51% (n=279) had undetectable HIV-1 RNA, including 54% of young women and 32% of young men (gender PR: 0.53; 95% CI: 0.43–0.80; p<0.001). Compared with older adults (30–64 years old), young HIV-infected adults were significantly less likely to have undetectable HIV-1 RNA (PR: 0.65; 95%CI: 0.59–0.70; p<0.0001), including both men (PR: 0.43; 95%CI: 0.34–0.56; p<0.0001) and women (PR: 0.67; 95%CI: 0.62–0.74; p<0.0001). Among a subset of PLHIV receiving ART, young adults also were less likely to have undetectable HIV-1 RNA load than older adults (PR: 0.93; 95%CI: 0.90–0.95; p=<0.0001). Analysis of the care continuum revealed that inferior HIV diagnosis and sub-optimal linkage to care are the primary reasons for low virologic suppression among young adults. Conclusions: Young adults in Botswana are significantly less likely to have undetectable HIV-1 RNA load compared with older adults. In the era of broad scale-up of ART, interventions able to diagnose young adults living with HIV and link them to effective therapy are urgently needed.

29771781

PMC6069598

CDC Public Access