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Cascade of HIV care and population viral suppression in a high-burden region of Kenya

AIDS, ISSN: 1473-5571, Vol: 29, Issue: 12, Page: 1557-1565
2015
  • 50
    Citations
  • 0
    Usage
  • 162
    Captures
  • 1
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    50
  • Captures
    162
  • Mentions
    1
    • News Mentions
      1
      • News
        1

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“Linkage to care” among people living with HIV – definition in the era of “universal test and treat” in a sub-Sahara African setting

Magnolini Raphael a b , Senkoro Elizabeth c , Vanobberghen Fiona d e , Weisser Maja a c d e Summary BACKGROUND Prompt linkage to

Article Description

Introduction: Direct measurement of antiretroviral treatment (ART) program indicators essential for evidence-based planning and evaluation especially HIV incidence, population viral load, and ART eligibility is rare in sub-Saharan Africa. Design/methods: To measure key indicators in rural western Kenya, an area with high HIV burden, we conducted a population survey in September to November 2012 via multistage cluster sampling, recruiting everyone aged 1559 years living in 3330 randomly selected households. Consenting individuals were interviewed and tested for HIV at home. Participants testing positive were assessed for CD4 cell count and viral load, and their infections classified as either recent or long term based on Limiting Antigen Avidity assays. HIV-negative participants were tested by nucleic acid amplification to detect acute infections. Results: Of 6833 household members eligible for the study, 6076 (94.7% of all women and 81.0% of men) agreed to participate. HIV prevalence and incidence were 24.1% [95% confidence interval [CI] 23.025.2] and 1.9 new cases/100 person-years (95% CI 1.12.7), respectively. Among HIV-positive participants, 59.4% (95% CI 56.861.9) were previously diagnosed, 53.1% (95% CI 50.555.7) were receiving care, and 39.7% (95% CI 37.142.4) had viral load less than 1000 copies/ml. Applying 2013 WHO recommendations for ART initiation increased the proportion of ART-eligible people from 60.0% (based on national guidelines in place during the survey; 95% CI 57.3 62.7) to 82.0% (95% CI 79.584.5). Among HIV-positive people not receiving ART, viral load increased with decreasing CD4 cell count (500749 vs. ≤750 cells/ml, adjusted mean difference, 0.40 log10 copies/ml, 95% CI 0.200.60, P<0.01). Conclusion: This study demonstrates how population-level data can help optimize HIV programs. Based on these results, new regional programs are prioritizing diagnosis and expanding ART eligibility, key steps to reach undetectable viral load.

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