ArticleJournal of the International AIDS Society2016
Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study.
Article in Journal of the International AIDS Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
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Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Use of HIV Recency Assays for HIV Incidence Estimation and Other Surveillance Use Cases: Systematic Review.JMIR public health and surveillance · 2022Pooled it
- The HIV care cascade in sub-Saharan Africa: systematic review of published criteria and definitions.Journal of the International AIDS Society · 2021Pooled it
- High rates of viral suppression in adults and children with high CD4+ counts using a streamlined ART delivery model in the SEARCH trial in rural Uganda and Kenya.Journal of the International AIDS Society · 2017Trial
- A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial.PLoS medicine · 2017Trial
- Achieving the fast track 90-90-90 and 95-95-95 targets in sub-Saharan Africa: A rapid review.Journal of public health in Africa · 2025Review
- Adolescents and young adults are the most undiagnosed of HIV and virally unsuppressed in Eastern and Southern Africa: Pooled analyses from five population-based surveys.PLOS global public health · 2023Article
- A systematic review of limiting antigen avidity enzyme immunoassay for detection of recent HIV-1 infection to expand supported applications.Journal of virus eradication · 2022Review
- Progress towards the UNAIDS 90-90-90 targets among persons aged 50 and older living with HIV in 13 African countries.Journal of the International AIDS Society · 2022Article
- Statistical considerations for cross-sectional HIV incidence estimation based on recency test.Statistics in medicine · 2022Article
- Uptake and Short-Term Retention in HIV Treatment Among Men in South Africa: The Coach Mpilo Pilot Project.Global health, science and practice · 2022Article
- Two-fold increase in the HIV viral load suppression rate along with decreased incidence over six years in Ndhiwa sub-county, Kenya.Tropical medicine & international health : TM & IH · 2021Article
- Inferring population HIV incidence trends from surveillance data of recent HIV infection among HIV testing clients.AIDS (London, England) · 2021Article
- What gaps remain in the HIV cascade of care? Results of a population-based survey in Nsanje District, Malawi.PloS one · 2021Article
- Successes and gaps in the HIV cascade of care of a high HIV prevalence setting in Zimbabwe: a population-based survey.Journal of the International AIDS Society · 2020Article
- Mixed-method estimation of population-level HIV viral suppression rate in the Western Cape, South Africa.BMJ global health · 2020Article
- "We give them threatening advice…": expectations of adherence to antiretroviral therapy and their consequences among adolescents living with HIV in rural Malawi.Journal of the International AIDS Society · 2020Article
- Phase-out of smallpox vaccination and the female/male HIV-1 prevalence ratio: an ecological study from Guinea-Bissau.BMJ open · 2019Article
- Optimal HIV testing strategies for South Africa: a model-based evaluation of population-level impact and cost-effectiveness.Scientific reports · 2019Article
- Point-of-care viral load monitoring: outcomes from a decentralized HIV programme in Malawi.Journal of the International AIDS Society · 2019Article
- Simplifying switch to second-line antiretroviral therapy in sub Saharan Africa: predicted effect of using a single viral load to define efavirenz-based first-line failure.AIDS (London, England) · 2019Article
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe 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.
methodsA 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.
resultsOf 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).
conclusionsThis 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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