BACKGROUND:
We
developed estimates of community viral load (VL) and risk factors for
unsuppressed VL from a cross-sectional study of men who have sex with men (MSM)
in Vancouver, Canada.
METHODS:
MSM were
recruited from February 25, 2012 - February 28, 2014 using Respondent-Driven
Sampling (RDS). Participants completed a computer assisted self-interview
questionnaire and a nurse-administered point-of-care HIV test. For HIV positive
participants, we conducted VL and CD4 cell counts. We used RDS-weighted
analysis to obtain population estimates of key variables and multivariable
logistic regression to examine factors associated with having a VL ≥200
copies/mL among HIV-positive participants.
RESULTS:
We
recruited 719 participants, of whom 119 (16.6%) were seeds. Our estimate of the
population HIV prevalence was 23.4% (95% CI 15.8 - 31.0%) after
RDS-adjustments. We estimated that 18.6% (95% confidence interval [CI] 8.8 -
30.4%) of HIV-positive MSM in Vancouver had a VL ≥200 copies/mL. Having an
unsuppressed VL was associated with non-Caucasian ethnicity (adjusted odds
ratio [AOR]= 4.34; 95% CI 1.67- 11.1); an annual income of <$15,000 CAD
(AOR=6.43; 95%CI 2.08-19.9); using GHB in the previous six months (AOR=4.85;
95%CI 1.79-13.2); unprotected anal intercourse with a known HIV negative or
unknown serostatus partner (AOR=3.13; 95%CI 1.10-8.90); and disclosing one's
HIV serostatus ≥50% of the time (AOR=7.04; 95%CI 1.01-49.1).
CONCLUSION:
Despite
a high prevalence of HIV, we estimated that a small proportion of HIV positive
MSM have undiagnosed HIV and unsuppressed VL. Our results highlight the
importance of continued work to address health inequities using a social
determinants of health framework.
By: Moore DM1, Cui Z, Lachowsky N, Raymond HF, Roth E, Rich A, Sereda P, Howard T, McFarland W, Lal A, Montaner J, Corneil T, Hogg RS; Momentum Health Study team.
- 1Department of Medicine, University of British Columbia, Vancouver, Canada
- 2 BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
- 3 University of California - San Francisco, San Francisco, United States
- 4 University of Victoria, Victoria, Canada
- 5 Positive Living Society of BC, Vancouver, Canada 6Interior Health, Kelowna, Canada 7Simon Fraser University, Burnaby, Canada.
- J Acquir Immune Defic Syndr. 2016 Jan 27.
Below: HIV Cascade of care, Ndhiwa, Kenya, 2012
Of 6833 household members eligible for the study, 6076 (94.7% of all women and 81.0% of men) agreed to participate. HIV prevalence and incidence were 24.1% [95% confidence interval [CI] 23.0–25.2] and 1.9 new cases/100 person-years (95% CI 1.1–2.7), respectively. Among HIV-positive participants, 59.4% (95% CI 56.8–61.9) were previously diagnosed, 53.1% (95% CI 50.5–55.7) were receiving care, and 39.7% (95% CI 37.1–42.4) had viral load less than 1000 copies/ml. Applying 2013 WHO recommendations for ART initiation increased the proportion of ART-eligible people from 60.0% (based on national guidelines in place during the survey; 95% CI 57.3–62.7) to 82.0% (95% CI 79.5–84.5). Among HIV-positive people not receiving ART, viral load increased with decreasing CD4+ cell count (500–749 vs. ≥750 cells/μl, adjusted mean difference, 0.40 log10 copies/ml, 95% CI 0.20–0.60, P < 0.01).
This study demonstrates how population-level data can help optimize HIV programs. Based on these results, new regional programs are prioritizing diagnosis and expanding ART eligibility, key steps to reach undetectable viral load.
Read more at: http://ht.ly/QW8yg HT @MSF
