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Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study

INTRODUCTION: The antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub-Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population surve...

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Autores principales: Maman, David, Chilima, Benson, Masiku, Charles, Ayouba, Ahidjo, Masson, Sophie, Szumilin, Elisabeth, Peeters, Martine, Ford, Nathan, Heinzelmann, Annette, Riche, Benjamin, Etard, Jean-François
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760102/
https://www.ncbi.nlm.nih.gov/pubmed/26894388
http://dx.doi.org/10.7448/IAS.19.1.20673
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author Maman, David
Chilima, Benson
Masiku, Charles
Ayouba, Ahidjo
Masson, Sophie
Szumilin, Elisabeth
Peeters, Martine
Ford, Nathan
Heinzelmann, Annette
Riche, Benjamin
Etard, Jean-François
author_facet Maman, David
Chilima, Benson
Masiku, Charles
Ayouba, Ahidjo
Masson, Sophie
Szumilin, Elisabeth
Peeters, Martine
Ford, Nathan
Heinzelmann, Annette
Riche, Benjamin
Etard, Jean-François
author_sort Maman, David
collection PubMed
description INTRODUCTION: The antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub-Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district. METHODS: A cross-sectional household-based survey was conducted between February and May 2013. Using a multistage cluster sampling method, we recruited all individuals aged 15 to 59 years living in 4125 randomly selected households. Each consenting individual was interviewed and tested for HIV at home. All participants who tested positive had their CD4 count and viral load measured. The LAg-Avidity assay was used to distinguish recent from long-term infections. Viral suppression was defined as a viral load below 1000 copies/mL. RESULTS: Of 8271 individuals eligible for the study, 7269 agreed to participate and were tested for HIV (94.1% inclusion for women and 80.3% for men). Overall HIV prevalence and incidence were 17.0% (95% CI 16.1 to 17.9) and 0.39 new cases per 100 person-years (95% CI 0.0 to 0.77), respectively. Coverage at the other steps along the HIV care cascade was as follows: 76.7% (95% CI 74.4 to 79.1) had been previously diagnosed, 71.2% (95% CI 68.6 to 73.6) were under care and 65.8% (95% CI 62.8 to 68.2) were receiving ART. Finally, the proportion of participants who were HIV positive with a viral load ≤1000 copies/mL reached 61.8% (95% CI 59.0 to 64.5). CONCLUSIONS: This study demonstrates that a high level of population viral suppression and low incidence can be achieved in high HIV prevalence and resource-limited settings.
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spelling pubmed-47601022016-02-22 Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study Maman, David Chilima, Benson Masiku, Charles Ayouba, Ahidjo Masson, Sophie Szumilin, Elisabeth Peeters, Martine Ford, Nathan Heinzelmann, Annette Riche, Benjamin Etard, Jean-François J Int AIDS Soc Research Article INTRODUCTION: The antiretroviral therapy (ART) programme supported by Médecins Sans Frontières in the rural Malawian district of Chiradzulu was one of the first in sub-Saharan Africa to scale up ART delivery in 2002. After more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district. METHODS: A cross-sectional household-based survey was conducted between February and May 2013. Using a multistage cluster sampling method, we recruited all individuals aged 15 to 59 years living in 4125 randomly selected households. Each consenting individual was interviewed and tested for HIV at home. All participants who tested positive had their CD4 count and viral load measured. The LAg-Avidity assay was used to distinguish recent from long-term infections. Viral suppression was defined as a viral load below 1000 copies/mL. RESULTS: Of 8271 individuals eligible for the study, 7269 agreed to participate and were tested for HIV (94.1% inclusion for women and 80.3% for men). Overall HIV prevalence and incidence were 17.0% (95% CI 16.1 to 17.9) and 0.39 new cases per 100 person-years (95% CI 0.0 to 0.77), respectively. Coverage at the other steps along the HIV care cascade was as follows: 76.7% (95% CI 74.4 to 79.1) had been previously diagnosed, 71.2% (95% CI 68.6 to 73.6) were under care and 65.8% (95% CI 62.8 to 68.2) were receiving ART. Finally, the proportion of participants who were HIV positive with a viral load ≤1000 copies/mL reached 61.8% (95% CI 59.0 to 64.5). CONCLUSIONS: This study demonstrates that a high level of population viral suppression and low incidence can be achieved in high HIV prevalence and resource-limited settings. International AIDS Society 2016-02-15 /pmc/articles/PMC4760102/ /pubmed/26894388 http://dx.doi.org/10.7448/IAS.19.1.20673 Text en © 2016 Maman D et al; licensee International AIDS Society http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Maman, David
Chilima, Benson
Masiku, Charles
Ayouba, Ahidjo
Masson, Sophie
Szumilin, Elisabeth
Peeters, Martine
Ford, Nathan
Heinzelmann, Annette
Riche, Benjamin
Etard, Jean-François
Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study
title Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study
title_full Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study
title_fullStr Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study
title_full_unstemmed Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study
title_short Closer to 90–90–90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study
title_sort closer to 90–90–90. the cascade of care after 10 years of art scale-up in rural malawi: a population study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760102/
https://www.ncbi.nlm.nih.gov/pubmed/26894388
http://dx.doi.org/10.7448/IAS.19.1.20673
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