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Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa

dc.rights.licenseopenen_US
dc.contributor.authorLARMARANGE, Joseph
dc.contributor.authorBACHANAS, Pamela
dc.contributor.authorSKALLAND, Timothy
dc.contributor.authorBALZER, Laura B
dc.contributor.authorIWUJI, Collins
dc.contributor.authorFLOYD, Sian
dc.contributor.authorMILLS, Lisa A
dc.contributor.authorPILLAY, Deenan
dc.contributor.authorHAVLIR, Diane
dc.contributor.authorKAMYA, Moses R
dc.contributor.authorAYLES, Helen
dc.contributor.authorWIRTH, Kathleen
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorDABIS, Francois
dc.contributor.authorHAYES, Richard
dc.contributor.authorPETERSEN, Maya
dc.date.accessioned2023-11-07T14:13:38Z
dc.date.available2023-11-07T14:13:38Z
dc.date.issued2023-07-14
dc.identifier.issn2767-3375en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/184663
dc.description.abstractEnUniversal 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 interventions to leverage linkage to treatment, adapted to local contexts, can reduce HIV acquisition at population level.
dc.language.isoENen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.title.enPopulation-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa
dc.title.alternativePLOS Glob Public Healthen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1371/journal.pgph.0002157en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed37450436en_US
dc.description.sponsorshipEuropeEDCTP-Plus: Laying the foundations for the EDCTP-II programmeen_US
bordeaux.journalPLOS Global Public Healthen_US
bordeaux.pagee0002157en_US
bordeaux.volume3en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue7en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamGHIGSen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDNational Institute of Allergy and Infectious Diseasesen_US
bordeaux.identifier.funderIDBill and Melinda Gates Foundationen_US
bordeaux.identifier.funderIDNational Institute on Drug Abuseen_US
bordeaux.identifier.funderIDNational Institute of Mental Health and Neurosciencesen_US
bordeaux.identifier.funderIDNational Institutes of Healthen_US
bordeaux.identifier.funderIDMedical Research Councilen_US
bordeaux.identifier.funderIDForeign, Commonwealth and Development Officeen_US
bordeaux.identifier.funderIDAgence Nationale de Recherches sur le Sida et les Hépatites Viralesen_US
bordeaux.identifier.funderIDDeutsche Gesellschaft für Internationale Zusammenarbeiten_US
bordeaux.identifier.funderIDGilead Sciencesen_US
bordeaux.import.sourcepubmed
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exportfalse
workflow.import.sourcepubmed
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&amp;rft_val_fmt=info:ofi/fmt:kev:mtx:journal&amp;rft.jtitle=PLOS%20Global%20Public%20Health&amp;rft.date=2023-07-14&amp;rft.volume=3&amp;rft.issue=7&amp;rft.spage=e0002157&amp;rft.epage=e0002157&amp;rft.eissn=2767-3375&amp;rft.issn=2767-3375&amp;rft.au=LARMARANGE,%20Joseph&amp;BACHANAS,%20Pamela&amp;SKALLAND,%20Timothy&amp;BALZER,%20Laura%20B&amp;IWUJI,%20Collins&amp;rft.genre=article


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