ArticleJournal of the International AIDS Society2024
Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viraemia during Universal Test and Treat scale-up in Uganda: a population-based study.
Article in Journal of the International AIDS Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 7 citations in OpenAlex.
- Anticipated Determinants and Strategies Supporting Same-Day HIV Preexposure Prophylaxis Implementation During Emergency Care Encounters in Kenya: A Qualitative Study.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Women engaged in commercial sex living with Human Immunodeficiency Virus and viral non-suppression in Uganda: analysis of multiple respondent-driven sampling surveys, 2021-2023.BMC global and public health · 2026Article
- HIV low-level viraemia: considerations for prevention and treatment in an era of highly effective and durable antiretroviral therapy regimens.Journal of the International AIDS Society · 2026Article
- Trends in advanced HIV disease, treatment interruption, and viraemia in KwaZulu-Natal, South Africa.PLOS global public health · 2026Article
- Maintain the gains: methods to evaluate the sustainability and scalability of HIV-related prevention, care, and treatment programs.Current opinion in HIV and AIDS · 2025Review
- Predictors of sustained human immunodeficiency virus viral-load suppression before and after the adoption of Treat All policy in Rwanda.World journal of virology · 2025Article
- The cumulative prevalence of HIV-1 drug resistance in perinatal HIV.AIDS (London, England) · 2025Observational
- A Guide to the Evolving Clinical Landscape of Low-Level Viremia Among Persons with HIV in the Modern Treatment Era.Current HIV/AIDS reports · 2025Review
- Prevalence and factors associated with HIV viral rebound in individuals on ART: A systematic review study.Journal of public health in Africa · 2025Review
- Household transport ownership and HIV viral suppression in rural Uganda: a cross- sectional, population-based study.Research square · 2024Article
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23 authors at 5 institutions in 3 countries.
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Abstract
introductionPopulation-level data on durable HIV viral load suppression (VLS) following the implementation of Universal Test and Treat (UTT) in Africa are limited. We assessed trends in durable VLS and viraemia among persons living with HIV in 40 Ugandan communities during the UTT scale-up.
methodsIn 2015-2020, we measured VLS (<200 RNA copies/ml) among participants in the Rakai Community Cohort Study, a longitudinal population-based HIV surveillance cohort in southern Uganda. Persons with unsuppressed viral loads were characterized as having low-level (200-999 copies/ml) or high-level (≥1000 copies/ml) viraemia. Individual virologic outcomes were assessed over two consecutive RCCS survey visits (i.e. visit-pairs; ∼18-month visit intervals) and classified as durable VLS (<200 copies/ml at both visits), new/renewed VLS (<200 copies/ml at follow-up only), viral rebound (<200 copies/ml at initial visit only) or persistent viraemia (≥200 copies/ml at both visits). Population prevalence of each outcome was assessed over calendar time. Community-level prevalence and individual-level predictors of persistent high-level viraemia were also assessed using multivariable Poisson regression with generalized estimating equations.
resultsOverall, 3080 participants contributed 4604 visit-pairs over three survey rounds. Most visit-pairs (72.4%) exhibited durable VLS, with few (2.5%) experiencing viral rebound. Among those with any viraemia at the initial visit (23.5%, n = 1083), 46.9% remained viraemic through follow-up, 91.3% of which was high-level viraemia. One-fifth (20.8%) of visit-pairs exhibiting persistent high-level viraemia self-reported antiretroviral therapy (ART) use for ≥12 months. Prevalence of persistent high-level viraemia varied substantially across communities and was significantly elevated among young persons aged 15-29 years (vs. 40- to 49-year-olds; adjusted risk ratio [adjRR] = 2.96; 95% confidence interval [95% CI]: 2.21-3.96), males (vs. females; adjRR = 2.40, 95% CI: 1.87-3.07), persons reporting inconsistent condom use with non-marital/casual partners (vs. persons with marital/permanent partners only; adjRR = 1.38, 95% CI: 1.10-1.74) and persons reporting hazardous alcohol use (adjRR = 1.09, 95% CI: 1.03-1.16). The prevalence of persistent high-level viraemia was highest among males <30 years (32.0%).
conclusionsFollowing universal ART provision, most persons living with HIV in south-central Uganda are durably suppressed. Among persons exhibiting any viraemia, nearly half exhibited high-level viraemia for ≥12 months and reported higher-risk behaviours associated with onward HIV transmission. Intensified efforts linking individuals to HIV treatment services could accelerate momentum towards HIV epidemic control.
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