International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.
Lancet HIV. 2022 Nov;9(11):e751-e759. doi: 10.1016/S2352-3018(22)00237-5.
In 2014, UNAIDS set the target that 90% of individuals on antiretroviral therapy (ART) be virally suppressed. Here, we use data from the HPTN 071 (PopART) trial to report whether the introduction of universal testing and treatment has affected viral suppression or treatment adherence among individuals who self-reported they were taking ART, and identify risk factors for these outcomes.
This was a cross-sectional study nested within the randomly selected population cohort of the PopART trial. The trial took place in 21 communities in Zambia and South Africa. Analyses included 3570 HIV-positive participants who were seen at the second follow-up visit in 2016-17 and who self-reported that they were currently taking ART. Viral suppression was defined as HIV RNA of less than 400 copies per mL from a blood sample collected during the cohort visit, and ART adherence was measured using self-reporting (reported as no missed pills in last 7 days). Prevalences of these outcomes were compared across three trial arms using a two-stage approach suitable for clustered data. Each arm consisted of seven communities, with one arm receiving a combination HIV prevention package including immediate ART initiation, one receiving a combination HIV prevention package excluding immediate ART initiation and one arm receving standard of care. Risk factors for each of the outcomes were assessed using logistic regression.
Among the 3570 participants who self-reported that they were currently on ART, 416 (11·7%) of 3554 were not virally suppressed (16 were missing viral suppression status) and 345 (9·7%) of 3566 reported being non-adherent to ART (four were missing adherence status). The proportion not virally suppressed was higher in communities in South Africa (195 [16·4%] of 1191) than in Zambia (221 [9·4%] of 2363). There was no evidence that the prevalence of the outcomes differed between trial arms. There was evidence that men, younger individuals, individuals who reported participating in harmful alcohol use, and those who reported internalised stigma were more likely to be non-adherent, and not virally suppressed.
The results assuaged concerns that early ART initiation in a universal testing and treatment setting could lead to reduced adherence and viral suppression.
US National Institute of Allergy and Infectious Diseases (which is a part of the National Institutes of Health), the International Initiative for Impact Evaluation with support from the Bill & Melinda Gates Foundation, US President's Emergency Plan for AIDS Relief, and Medical Research Council UK.
2014 年，联合国艾滋病规划署设定了将 90%接受抗逆转录病毒疗法（ART）的患者病毒抑制的目标。在这里，我们使用 HPTN 071（PopART）试验的数据报告，在引入普遍检测和治疗后，对自我报告正在接受 ART 的患者的病毒抑制或治疗依从性是否产生影响，并确定这些结果的风险因素。
这是一项嵌套在 PopART 试验中随机选择的人群队列中的横断面研究。该试验在赞比亚和南非的 21 个社区进行。分析包括在 2016-17 年的第二次随访中观察到的 3570 名 HIV 阳性参与者，他们自我报告目前正在接受 ART。病毒抑制定义为从队列就诊期间采集的血液样本中 HIV RNA 小于 400 拷贝/ml，使用自我报告（报告为过去 7 天内未错过任何药物）测量 ART 依从性。使用适合聚类数据的两阶段方法，比较三个试验臂之间的这些结果的流行率。每个臂由七个社区组成，一个臂接受包括立即开始 ART 的综合 HIV 预防方案，一个臂接受不包括立即开始 ART 的综合 HIV 预防方案，一个臂接受标准护理。使用逻辑回归评估每个结果的风险因素。
在 3570 名自我报告目前正在服用 ART 的参与者中，有 345 名（9.7%）报告不依从 ART（4 名缺失依从性状态），有 416 名（11.7%）未被病毒抑制（16 名未报告病毒抑制状态）。南非社区中未被病毒抑制的比例高于赞比亚（南非 1191 名参与者中有 195 名[16.4%]，赞比亚 2363 名参与者中有 221 名[9.4%]）。没有证据表明试验臂之间的结果流行率存在差异。有证据表明，男性、年轻人、报告参与有害酒精使用的人和报告内化耻辱感的人更有可能不依从，且未被病毒抑制。
结果减轻了人们对在普遍检测和治疗环境中早期开始 ART 会导致依从性和病毒抑制降低的担忧。
美国国立过敏和传染病研究所（它是美国国立卫生研究院的一部分）、国际影响力评估倡议，得到比尔和梅琳达盖茨基金会的支持、美国总统艾滋病紧急救援计划和英国医学研究理事会。
