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South Africa has the largest number of people living with HIV worldwide. South Africa has implemented five population-based HIV prevalence surveys since 2002 aimed at understanding the dynamics and the trends of the epidemic. This paper presents key findings from the fifth HIV prevalence, incidence, and behaviour survey conducted in 2017 following policy, programme, and epidemic change since the prior survey was conducted in 2012. A cross-sectional population-based household survey collected behavioural and biomedical data on all members of the eligible households. A total of 39,132 respondents from 11,776 households were eligible to participate, of whom 93.6% agreed to be interviewed, and 61.1% provided blood specimens. The provided blood specimens were used to determine HIV status, HIV incidence, viral load, exposure to antiretroviral treatment, and HIV drug resistance. Overall HIV incidence among persons aged 2 years and above was 0.48% which translates to an estimated 231,000 new infections in 2017. HIV prevalence was 14.0% translating to 7.9 million people living with HIV. Antiretroviral (ARV) exposure was 62.3%, with the lowest exposure among those aged 15 to 24 years (39.9%) with 10% lower ARV coverage among males compared to females. Viral suppression among those on treatment was high (87.3%), whilst HIV population viral load suppression was much lower (62.3%). In terms of risk behaviours, 13.6% of youth reported having had an early sexual debut (first sex before the age of 15 years), with more males reporting having done so (19.5%) than females (7.6%). Age-disparate relationships, defined as having a sexual partner 5+ years different from oneself,) among adolescents were more common among females (35.8%) than males (1.5%). Self-reported multiple sexual partnerships (MSPs), defined as having more than one sexual partner in the previous 12 months, were more commonly reported by males (25.5%) than females (9.0%). Condom use at last sexual encounter was highest among males than females. Three quarters (75.2%) of people reported they had ever been tested for HIV, with more females (79.3%) having had done so than males (70.9%). Two-thirds of respondents (66.8%) self-reported having tested for HIV in the past 12 months. Finally, 61.6% of males in the survey self-reported as having been circumcised, with circumcision being more common among youth aged 15–24 years (70.2%), Black Africans (68.9%), and those living in both rural informal (tribal) areas (65%) and urban areas (61.9%). Slightly more (51.2%) male circumcisions were reported to have occurred in a medical setting than in traditional settings (44.8%), with more young males aged 15–24 (62.6%) and men aged 25–49 (51.5%) reporting to have done so compared to most men aged 50 and older (57.1%) who reported that they had undergone circumcision in a traditional setting. The results of this survey show that strides have been made in controlling the HIV epidemic, especially in the reduction of HIV incidence, HIV testing, and treatment. Although condom use at last sex act remains unchanged, there continue to be some challenges with the lack of significant behaviour change as people, especially youth, continue to engage in risky behaviour and delay treatment initiation. Therefore, there is a need to develop or scale up targeted intervention programmes to increase HIV testing further and put more people living with HIV on treatment as well as prevent risky behaviours that put young people at risk of HIV infection.

This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.

Background Rwanda has made remarkable progress in scaling up HIV testing, treatment, and healthcare services. Recent data show that 95% of people living with HIV (PLWH) were aware of their status, 97.5% of them are on antiretroviral therapy (ART), and 98% of those who are on treatment have achieved viral suppression. Importantly, growing body of evidence supports the Undetectable = Untransmittable (U = U) concept, affirming that PLWH who maintain an undetectable viral load do not transmit HIV to their sexual partners. This pivotal breakthrough in HIV care has transformed public health strategies and stigma reduction efforts. This study aimed to explore the perspectives of PLWH on the U = U concept in health facilities in Rwanda. Methods An exploratory qualitative study was conducted at three purposively selected health facilities in Rwanda from December 1 to 30, 2023. An interview guide was used to collect data, and data saturation was reached after enrolling 43 PLWH. The data was analyzed using conventional thematic analysis. Results The majority of participants demonstrated good knowledge of HIV transmission, with the U = U concept being particularly well-understood among discordant couples and individuals who have been on treatment for over 10 years. Three themes emerged from the analysis: [ 1 ] comprehensive knowledge of HIV transmission among PLWH; [ 2 ] reasons for disclosing HIV status and linking to care; and [ 3 ] acceptability of the U = U concept. Conclusion Our findings highlight the necessity for broader dissemination of the U = U concept across all PLWH subpopulations. Further research is essential to better understand the challenges faced by PLWH, which is critical for achieving the UNAIDS goal of ending the HIV/AIDS epidemic by 2030.

Background Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10–19 years) on antiretroviral therapy (ART) in Harare city. Methods We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p -values at 95% CI. Results We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80–11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22–22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20–9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01–0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23–0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21–0.80)] were protective. Conclusion Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure.

Unsuppressed viral load count in patients on anti-retroviral therapy is linked to poorer survival and increased transmission of the virus. Despite efforts made in Ethiopia, the viral load suppression rate is still low. To estimate time to viral load suppression and predictors of viral load suppression among adults on anti-retroviral therapy in Nigist Elen Mohamed Memorial Comprehensive Specialized Hospital, 2022. A retrospective follow-up study was conducted among 297 adults on anti-retroviral therapy from January 1, 2016, to December 31, 2021. A simple random sampling technique was used to select study participants. The data were analyzed using STATA 14. Cox regression model was used. The adjusted hazard ratio with 95% CI was estimated. A total of 296 records of patients on anti-retroviral therapy were included in this study. The incidence of viral load suppression was 9.68 per 100-person months. The median time for viral load suppression was 9 months. Patients with baseline CD4 ≥200 cell/mm (AHR: 1.87; 95% CI = 1.34, 2.63), who had no opportunistic infections (AHR = 1.84; 95% CI = 1.34, 2.52), who were on WHO clinical stage-I or II (AHR = 2.12; 95% CI = 1.18, 3.79) and who have taken tuberculosis preventive therapy (AHR = 2.24; 95% CI = 1.66, 3.02) had higher hazards of viral load suppression. The median time for viral load suppression was 9 months. Patients who had no opportunistic infection, with higher CD4 count, on WHO clinical stage-I or II, who have taken tuberculosis preventive therapy had higher hazards of viral load suppression. Careful monitoring and counseling of patients with CD4 levels lower than 200 cells/mm3 are necessary. Careful monitoring and counseling of patients in advanced WHO clinical stages, with lower CD4 count levels and with opportunistic infections is crucial. Strengthening the provision of tuberculosis preventive therapy is warranted.

Background and Objectives There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients. Design This is a cross-sectional study. Participants and Setting Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort. Measurements Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to <50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression. Results Among 104 participants, 51% were food secure, 24% were mildly or moderately food insecure and 25% were severely food insecure. Severely food insecure participants were less likely to have adherence >=80%. In adjusted analyses, severe food insecurity was associated with a 77% lower odds of viral suppression (95% CI = 0.06–0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85% lower odds of viral suppression (95% CI = 0.02–0.99) among those with <=80% adherence and a 66% lower odds among those with >80% adherence (95% CI = 0.06–1.81). Conclusions Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.

Background Availability and accessibility of Antiretroviral drugs (ARV’s) improve the lives of People living with HIV (PLHIV) by improving client’s immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels. Methods A retrospective longitudinal study design study was conducted from 1 st October, 2018 to 30 th June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load <1,000 HIV RNA copies/ml (viral load suppression). Cox proportional hazard regression models were employed to identify risk factors for virological failure. P values were two-sided, and we considered a P <0.05 to be statistically significant. Results Fifty-nine thousand five hundred three adult clients >15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - <25 years (HR: 2.82, 95% CI 1.96 – 4.04), BMI <18.5 (HR: 1.69, 95% CI 1.23 – 2.30), advanced WHO stage IV (HR: 1.60, 95% CI 1.12 – 2.24), CD4 cell count <350 (HR: 2.61, 95% CI 2.12 – 3.23), poor adherence (HR: 1.98, 95% CI 1.80 – 2.18) and not using DTG based drug (HR: 11.8, 95% CI 9.74 – 14.3). Conclusion Virologic failure was observed in this study among clients with young age, advanced WHO stage IV, not using DTG based regimen, poor drug adherence and second line regime. To improve Viral Load Suppression among these clients; the existing HIV intervention strategies should be taken care by targeting the identified risk factors.

Background Achieving the UNAIDS 95% sustained viral suppression (VS) rate requires considerable global efforts, particularly among adolescents living with HIV (ALHIV) who are often associated with high rates of virological failure (VF). In this study, we prospectively assessed the rate of VS, and the factors associated with VF in a cohort of adolescents followed up according to the WHO guidelines in Cameroon. Methods A cross-sectional study was carried out in 2021 among adolescents (aged 10–19 years) receiving ART in the national program in Cameroon. Socio-demographic and clinical data were collected using patients’ medical files and a brief interview with the participant and/or his guardian. Thereafter, a first viral load test (VL1) was performed using the ABBOTT Platform. For adolescents with VL1 > 1000 copies/ml, adherence-enhancing interventions were routinely performed each month for 3 consecutive months, after which a second viral load (VL2) was measured. Adolescents with VL2 > 1000 copies/ml were considered in VF. Results Overall, 280 adolescents were enrolled, of whom 89.3% (250/280) acquired HIV infection via mother-to-child transmission. The median age was 16.0 (IQR: 13.0–18.0) years and the median duration on ART was 9.8 (IQR: 5.1–12.8) years. Females and males were almost equally represented, as 52.1% (146/280) were female, while 47.9% (134/280) were males (p = 0.47). The VS rate was 88.2% (CI: 83.8-91.7%) overall; 89.0% (CI: 82.0-93.1%) and 88.7% (CI: 81.2-93.0%) in females and males, respectively. Being on second or third-line ART, self-declared suboptimal adherence, and a history of past VF were independently associated with VF. Conclusion The high rate of VS we report in this study is welcome in the era of the 95/95/95 UNAIDS goals, and indicates that improving treatment outcomes in this specific and fragile population that represent adolescents in Sub-Saharan Africa is achievable. Trial registration 20/10/2020 NCT04593979 ( https://clinicaltrials.gov/ct2/show/NCT04593979 ).

Introduction With the rapid spread of COVID-19, many governments put various measures in place to contain the spread of the pandemic. These measures, such as travel restrictions, curfews, and public gatherings, may affect health service delivery, including monitoring of viral load and CD4 for People Living with HIV (PLHIV) on antiretroviral therapy (ART). Lesotho is a lower-middle-income country with one of the world’s highest prevalence of HIV (22%). This study aims to examine the effect of COVID-19 on viral load and CD4 monitoring of PLHIV on ART in Lesotho. Methods We employed routine data from seven Ministry of Health health centers supported by Partners In Health from March 2017 to February 2023. We extracted de-identified data for all patients with HIV on ART who were followed by the health centers, including demographic variables of interest, viral load, and CD4 count. We analyzed the data using the chi-squared tests of independence to compare before and after COVID-19, and we used a logistic regression model predicting a result of “suppressed” and advanced disease as binary outcome variables. Results We observed significantly higher rates of viral load suppression and CD4 counts > 200 with p-values < 0.001 during the COVID-19 pandemic, March 2020, 2021, 2022, and 2023, versus before the pandemic in March 2017, 2018, 2019, and February 2020. Fewer patients seen during the pandemic were classified as having “advanced HIV” based on CD4 count (< 200 cells/ml) test results during COVID (7.0%) than before (8.0%), though it was no significant and likewise, fewer PLHIV seen during the COVID-19 pandemic were “unsuppressed” based on viral load (> 1000 copies/ml) (11.1%) vs. before the pandemic (15.8%) which was significant with p-value < 0.001. Conclusions Maintaining high viral load suppression in remote and rural communities during the pandemic is possible. A robust primary health system and strong pandemic preparation and response plans are crucial for effective HIV program response. Measures and communication introduced into the viral load and CD4 monitoring during the pandemic outbreak are paramount for sustaining the viral load suppression and ultimately reducing new HIV transmission.

Background Despite effective antiretroviral therapy (ART) coverage in other groups living with human immunodeficiency virus (HIV) in Tanzania, virologic suppression among HIV-positive children receiving ART remains unacceptably low. This study evaluated the effectiveness of a community-based intervention (Konga model) in addressing the factor contributing to low viral load suppression among children living with HIV in the Simiyu region, Tanzania. Methods This study used a parallel cluster randomized trial. The cluster was only eligible if the health facility provided HIV care and treatment. All eligible resident children aged 2‒14 years who attended the cluster with a viral load > 1,000 cells/mm were enrolled. The intervention included three distinct activities: adherence counseling, psychosocial support, and co-morbidity screening such as tuberculosis. The evaluation was based on patient-centered viral load outcomes measured at baseline and 6 months later. Using a pre- and post-test design, we compared the means of participants in the intervention and control groups. We performed an analysis of covariance. The effect of a Konga was calculated using omega-squared. We used F-tests, with their corresponding p-values, as measures of improvement. Results We randomly assigned 45 clusters to the treatment (15) and control (30) groups. We enrolled 82 children with amedian age of 8.8 years(interquartile range(IQR);5.5–11.2), and a baseline median viral load of 13,150 cells/mm (interquartile range (IQR);3600–59,200). After the study, both children in each group had good adherence, with children in the treatment group scoring slightly higher than those in the control group, 40 (97.56%) versus 31(75%61), respectively. At the end of the study, the difference in viral load suppression between the two groups was significant. The median viral load suppression at the end of the study was 50 cells/mm [IQR, (20–125)]. After adjusting for the viral load before the intervention, the effect size of the Konga intervention explained 4% (95% confidence interval [0%, 14.1%]) of the viral load variation at the end of the intervention. Conclusion The Konga model demonstrated significant positive effects that improved viral load suppression. We recommend implementing the Konga model trial in other regions to improve the consistency of results.