Lack of Virological Suppression among Young HIV-Positive Adults in Botswana

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Novitsky, Vlad ; Gaolathe, Tendani ; Mmalane, Mompati ; Moyo, Sikhulile ; Chakalisa, Unoda ; Yankinda, Etienne Kadima ; Marukutira, Tafireyi ; Holme, Molly Pretorius ; Sekoto, Tumalano ; Gaseitsiwe, Simani ; Musonda, Rosemary ; van Widenfelt, Erik ; Powis, Kathleen M. ; Khan, Nealia ; Dryden-Peterson, Scott ; Bennett, Kara ; Wirth, Kathleen E. ; Tchetgen, Eric Tchetgen ; Bachanas, Pam ; Mills, Lisa A. ; Lebelonyane, Refeletswe ; el-Halabi, Shenaaz ; Makhema, Joseph ; Lockman, Shahin ; Essex, M.
• Description:
  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.
  
  
• Subjects:
  Adolescent Adult Anti-HIV Agents Continuity Of Patient Care Female HIV-1 HIV Infections Humans Male Middle Aged RNA, Viral Surveys And Questionnaires Viral Load Young Adult

  More +
• Keywords:
  HIV-1C Epidemic HIV Suppression Receiving ART Virologically Suppressed Young Adults
• Source:
  J Acquir Immune Defic Syndr. 78(5):557-565
• Pubmed ID:
  29771781
• Pubmed Central ID:
  PMC6069598
• Document Type:
  Journal Article
• Funding:
  U01 GH000447/GH/CGH CDC HHSUnited States/ ; U2G GH001911/GH/CGH CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/ ; D43 TW010543/TW/FIC NIH HHSUnited States/ ; 107752/Z/15/Z/WT_/Wellcome TrustUnited Kingdom/
• Place as Subject:
  Botswana
• Volume:
  78
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6a899200c3ac7695278745bf043023f2b5011548839f19e5567ad5a1bd6e748e
• Download URL:
  https://stacks.cdc.gov/view/cdc/57797/cdc_57797_DS1.pdf
• File Type:
  [PDF - 331.45 KB ]