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HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa

BACKGROUND: The impact of HIV stigma on viral suppression among people living with HIV (PLHIV) is not well characterized. SETTING: Twenty-one communities in Zambia and South Africa, nested within the HPTN 071 (PopART) trial. METHODS: We analyzed data on viral suppression (<400 copies HIV RNA/mL)...

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Autores principales: Hargreaves, James R., Pliakas, Triantafyllos, Hoddinott, Graeme, Mainga, Tila, Mubekapi-Musadaidzwa, Constance, Donnell, Deborah, Piwowar-Manning, Estelle, Agyei, Yaw, Mandla, Nomhle F., Dunbar, Rory, Macleod, David, Floyd, Sian, Bock, Peter, Fidler, Sarah, Hayes, Richard J., Seeley, Janet, Stangl, Anne, Bond, Virginia, Ayles, Helen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JAIDS Journal of Acquired Immune Deficiency Syndromes 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654947/
https://www.ncbi.nlm.nih.gov/pubmed/32991336
http://dx.doi.org/10.1097/QAI.0000000000002504
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author Hargreaves, James R.
Pliakas, Triantafyllos
Hoddinott, Graeme
Mainga, Tila
Mubekapi-Musadaidzwa, Constance
Donnell, Deborah
Piwowar-Manning, Estelle
Agyei, Yaw
Mandla, Nomhle F.
Dunbar, Rory
Macleod, David
Floyd, Sian
Bock, Peter
Fidler, Sarah
Hayes, Richard J.
Seeley, Janet
Stangl, Anne
Bond, Virginia
Ayles, Helen
author_facet Hargreaves, James R.
Pliakas, Triantafyllos
Hoddinott, Graeme
Mainga, Tila
Mubekapi-Musadaidzwa, Constance
Donnell, Deborah
Piwowar-Manning, Estelle
Agyei, Yaw
Mandla, Nomhle F.
Dunbar, Rory
Macleod, David
Floyd, Sian
Bock, Peter
Fidler, Sarah
Hayes, Richard J.
Seeley, Janet
Stangl, Anne
Bond, Virginia
Ayles, Helen
author_sort Hargreaves, James R.
collection PubMed
description BACKGROUND: The impact of HIV stigma on viral suppression among people living with HIV (PLHIV) is not well characterized. SETTING: Twenty-one communities in Zambia and South Africa, nested within the HPTN 071 (PopART) trial. METHODS: We analyzed data on viral suppression (<400 copies HIV RNA/mL) among 5662 laboratory-confirmed PLHIV aged 18–44 years who were randomly sampled within the PopART trial population cohort 24 months after enrolment (PC24). We collected data on experiences and internalization of stigma from those PLHIV who self-reported their HIV status (n = 3963/5662) and data on perceptions of stigma from a 20% random sample of all PLHIV (n = 1154/5662). We also measured stigma at the community-level among PLHIV, community members, and health workers. We analyzed the association between individual- and community-level measures of HIV stigma and viral suppression among PLHIV, adjusting for confounding. RESULTS: Of all 5662 PLHIV, 69.1% were virally suppressed at PC24. Viral suppression was highest among those 3963 cohort participants who self-reported living with HIV and were on ART (88.3%), and lower among those not on treatment (37.5%). Self-identifying PLHIV who reported internalized stigma were less likely to be virally suppressed (75.0%) than those who did not (80.7%; adjusted risk ratio, 0.94 95% CI: 0.89 to 0.98). Experiences, perceptions, and community-level measures of stigma were not associated with viral suppression. CONCLUSION: Internalized stigma among PLHIV was associated with a lower level of viral suppression; other dimensions of stigma were not. Stigma reduction approaches that address internalized stigma should be an integral component of efforts to control the HIV epidemic.
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spelling pubmed-76549472020-11-16 HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa Hargreaves, James R. Pliakas, Triantafyllos Hoddinott, Graeme Mainga, Tila Mubekapi-Musadaidzwa, Constance Donnell, Deborah Piwowar-Manning, Estelle Agyei, Yaw Mandla, Nomhle F. Dunbar, Rory Macleod, David Floyd, Sian Bock, Peter Fidler, Sarah Hayes, Richard J. Seeley, Janet Stangl, Anne Bond, Virginia Ayles, Helen J Acquir Immune Defic Syndr Implementation Science BACKGROUND: The impact of HIV stigma on viral suppression among people living with HIV (PLHIV) is not well characterized. SETTING: Twenty-one communities in Zambia and South Africa, nested within the HPTN 071 (PopART) trial. METHODS: We analyzed data on viral suppression (<400 copies HIV RNA/mL) among 5662 laboratory-confirmed PLHIV aged 18–44 years who were randomly sampled within the PopART trial population cohort 24 months after enrolment (PC24). We collected data on experiences and internalization of stigma from those PLHIV who self-reported their HIV status (n = 3963/5662) and data on perceptions of stigma from a 20% random sample of all PLHIV (n = 1154/5662). We also measured stigma at the community-level among PLHIV, community members, and health workers. We analyzed the association between individual- and community-level measures of HIV stigma and viral suppression among PLHIV, adjusting for confounding. RESULTS: Of all 5662 PLHIV, 69.1% were virally suppressed at PC24. Viral suppression was highest among those 3963 cohort participants who self-reported living with HIV and were on ART (88.3%), and lower among those not on treatment (37.5%). Self-identifying PLHIV who reported internalized stigma were less likely to be virally suppressed (75.0%) than those who did not (80.7%; adjusted risk ratio, 0.94 95% CI: 0.89 to 0.98). Experiences, perceptions, and community-level measures of stigma were not associated with viral suppression. CONCLUSION: Internalized stigma among PLHIV was associated with a lower level of viral suppression; other dimensions of stigma were not. Stigma reduction approaches that address internalized stigma should be an integral component of efforts to control the HIV epidemic. JAIDS Journal of Acquired Immune Deficiency Syndromes 2020-12-15 2020-09-24 /pmc/articles/PMC7654947/ /pubmed/32991336 http://dx.doi.org/10.1097/QAI.0000000000002504 Text en Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Implementation Science
Hargreaves, James R.
Pliakas, Triantafyllos
Hoddinott, Graeme
Mainga, Tila
Mubekapi-Musadaidzwa, Constance
Donnell, Deborah
Piwowar-Manning, Estelle
Agyei, Yaw
Mandla, Nomhle F.
Dunbar, Rory
Macleod, David
Floyd, Sian
Bock, Peter
Fidler, Sarah
Hayes, Richard J.
Seeley, Janet
Stangl, Anne
Bond, Virginia
Ayles, Helen
HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa
title HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa
title_full HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa
title_fullStr HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa
title_full_unstemmed HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa
title_short HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa
title_sort hiv stigma and viral suppression among people living with hiv in the context of universal test and treat: analysis of data from the hptn 071 (popart) trial in zambia and south africa
topic Implementation Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654947/
https://www.ncbi.nlm.nih.gov/pubmed/32991336
http://dx.doi.org/10.1097/QAI.0000000000002504
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