Dataset Information

Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.

ABSTRACT: INTRODUCTION:The global target for 2020 is that ?90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months. METHODS:We analysed data from the population-based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross-sectional household surveys. Data collection included structured interviews, home-based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load <1000 copies/mL), nonsuppressed viral load (NVL; viral load ?1000 copies/mL), virologic failure (VF; ARVs present and viral load ?1000 copies/mL), interrupted ART (ARVs absent and viral load ?1000 copies/mL) and rates of switching to second-line ART (protease inhibitors present) among PLHIV aged 15 to 59 years who participated in the PHIA surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe, initiated ART at least four months before the survey and were receiving ART at the time of the survey (according to self-report or ARV testing). We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART. RESULTS:We included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts <200 cells/µL, but few (0.31% per year) switched to second-line ART. CONCLUSIONS:Countries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor- or integrase inhibitor-based regimens may further reduce NVL prevalence.

SUBMITTER: Haas AD

PROVIDER: S-EPMC7680921 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.

Haas Andreas D AD Radin Elizabeth E Hakim Avi J AJ Jahn Andreas A Philip Neena M NM Jonnalagadda Sasi S Saito Suzue S Low Andrea A Patel Hetal H Schwitters Amee M AM Rogers John H JH Frederix Koen K Kim Evelyn E Bello George G Williams Daniel B DB Parekh Bharat B Sachathep Karampreet K Barradas Danielle T DT Kalua Thokozani T Birhanu Sehin S Musuka Godfrey G Mugurungi Owen O Tippett Barr Beth A BA Sleeman Katrina K Mulenga Lloyd B LB Thin Kyaw K Ao Trong T TT Brown Kristin K Voetsch Andrew C AC Justman Jessica E JE

Journal of the International AIDS Society 20201101 11

<h4>Introduction</h4>The global target for 2020 is that ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months.<h4>Methods</h4>We analysed data from the population-based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross-sectional household su ...[more]

PMID: 33225559

Similar Datasets

Project description:BackgroundLinking facility and household surveys through geographic methods is a popular technique to draw conclusions about the relationship between health services and population health outcomes at local levels. These methods are useful tools for measuring effective coverage and tracking progress towards Universal Health Coverage, but are understudied. This paper compares the appropriateness of several geospatial methods used for linking individuals (within displaced survey cluster locations) to their source of family planning (at undisplaced health facilities) at a national level.MethodsIn Malawi, geographic methods linked a population health survey, rural clusters from the Woman's Questionnaire of the 2015 Malawi Demographic and Health Survey (MDHS 2015), to Malawi's national health facility census to understand the service environment where women receive family planning services. Individuals from MDHS 2015 clusters were linked to health facilities through four geographic methods: (i) closest facility, (ii) buffer (5 km), (iii) administrative boundary, and (iv) a newly described theoretical catchment area method. Results were compared across metrics to assess the number of unlinked clusters (data lost), the number of linkages per cluster (precision of linkage), and the number of women linked to their last source of modern contraceptive (appropriateness of linkage).ResultsThe closest facility and administrative boundary methods linked every cluster to at least one facility, while the 5-km buffer method left 288 clusters (35.3%) unlinked. The theoretical catchment area method linked all but one cluster to at least one facility (99.9% linked). Closest facility, 5-km buffer, administrative boundary, and catchment methods linked clusters to 1.0, 1.4, 21.1, and 3.3 facilities on average, respectively. Overall, the closest facility, 5-km buffer, administrative boundary, and catchment methods appropriately linked 64.8%, 51.9%, 97.5%, and 88.9% of women to their last source of modern contraceptive, respectively.ConclusionsOf the methods studied, the theoretical catchment area linking method loses a marginal amount of population data, links clusters to a relatively low number of facilities, and maintains a high level of appropriate linkages. This linking method is demonstrated at scale and can be used to link individuals to qualities of their service environments and better understand the pathways through which interventions impact health.

Project description:BackgroundGiven the rapid ongoing progression of the internet and increase in health information available from disparate online sources, it is important to understand how these changes impact online health information-seeking behavior of the population and the way of managing one's health.ObjectiveThis paper aims at describing the evolution of internet use as a source of health information between 2010 and 2017, as well as the characteristics of online health information seekers, topics of interest, sources of information, and trust in retrieved information and potential impact on behavior.MethodsData from the French nationally representative surveys Health Barometers were used (N=4141 in 2010, 4811 in 2014, and 6255 in 2017). Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models.ResultsThe use of the internet as a source of health information rose between 2010 and 2014 (from 37.3% to 67.9%, P<.001) but decreased significantly in 2017 (60.3%, P<.001). Overall, the profile of health information seekers compared with nonseekers did not change over time. They were more likely to be women, to be younger, to have a higher educational level, to have a higher household income, and to be executives. Between 2014 and 2017, the proportion of those who did not pay attention to the source of information significantly increased to reach 39.7% (P<.001). In 2017 as in 2014, general health-related websites remained the first source of information (38.6%) while institutional websites were the third source (8.1%). Most information seekers trusted the information found online in 2010 (more than 80%), with a slight decrease between 2014 and 2017 (P=.048). Among individual characteristics, trust in the information was the main determinant of the way of managing one's health (odds ratio 4.06, 95% CI 3.26-5.06).ConclusionsAfter a rapid growth in the internet use for seeking health information in the 2010 to 2014 period, a decrease was recorded in 2017, in parallel with a decrease in trust in the quality and reliability of information found online. These findings underline the need for public health authorities to increase citizens' eHealth literacy and to provide alternative trustworthy sources combining the popularity and accessibility of general health information websites.

Project description:ObjectiveThis study assessed the changes in prevalence and associated factors of tobacco smoking among Bangladeshi adults over time.DesignNationally representative cross-sectional surveys.SettingTwo most recent Global Adults Tobacco Survey (GATS) data from Bangladesh, carried out in 2009 and 2017.ParticipantsAdult population aged 15 and above (n=9629 in 2009; n=12 783 in 2017).Outcome measuresCurrent use of tobacco smoke, including cigarettes, bidi, hukkah, cigars or pipes, which was dichotomised ('yes'/'no').MethodsWe analysed data from two recent rounds of GATS (2009 and 2017). Multivariate logistic regression analysis was used.ResultsThe overall prevalence of tobacco smoking among Bangladeshi adults was noted (23.00%, 95% CI 22.98 to 23.00 in 2009; 16.44%, 95% CI 16.43 to 16.45 in 2017). Being male (adjusted OR (AOR)=59.72, CI 40.56 to 87.93 for 2009; AOR=71.17, CI 41.08 to 123.32 for 2017), age between 25 and 64 years (all AORs >2 and p<0.05), smoking permissible at home (AOR=7.08, CI 5.88 to 8.52 for 2009; AOR=5.90, CI 5.34 to 6.95 for 2017), and watching tobacco smoking product use in movie/drama scenes (AOR=1.26, CI 1.11 to 1.44 for 2009; AOR=1.34, CI 1.17 to 1.54 for 2017) were found to be significantly associated with increased tobacco smoking among adults both in 2009 and in 2017. However, being offered free tobacco sample products (AOR=0.66, CI 0.57 to 0.77 for 2009; AOR=0.87, CI 0.76 to 0.99 for 2017) and having primary, secondary or higher education (all AORs <1 and p<0.05) as well as being a student (AOR=0.16, CI 0.09 to 0.29 for 2009; AOR=0.32, CI 0.19 to 0.53) were associated with lower odds of tobacco smoking in both surveys.ConclusionsAlthough the prevalence of tobacco smoking has declined over the period, it is still high among those who were relatively older, men, less educated and exposed to a movie/drama where tobacco smoking is promoted. Therefore, appropriate interventions are required to stop tobacco smoking among the Bangladeshi population.

Project description:ObjectiveTo assess national and regional trends and causes-specific distribution of maternal mortality in India.DesignNationally representative cross-sectional surveys.SettingAll of India from 1997 to 2020.SampleAbout 10 000 maternal deaths among 4.3 million live births over two decades.MethodsWe analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country.Main outcome measuresMaternal mortality burden and distribution of causes.ResultsThe MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%).ConclusionsIndia could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.Tweetable abstractWe estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Project description:INTRODUCTION:HIV self-testing (HIVST) is being introduced as a new way for more undiagnosed people to know their HIV status. As countries start to implement HIVST, assuring the quality and regulating in vitro diagnostics, including HIVST, are essential. We aimed to document the emerging regulatory landscape and perceptions of key stakeholders involved in HIVST policy and regulation prior to implementation in three low- and middle-income countries. METHODS:Between April and August 2016, we conducted semi-structured interviews in Malawi, Zambia and Zimbabwe to understand the relationships between different stakeholders on their perceptions of current and future HIVST regulation and the potential impact on implementation. We purposively sampled and interviewed 66 national-level key stakeholders from the Ministry of Health and the regulatory, laboratory, logistical, donor and non-governmental sectors. We used a thematic approach to analysis with an inductively developed common coding framework to allow inter-country comparison of emerging themes. RESULTS:In all countries, the national reference laboratory was monitoring the quality of HIVST kits entering the public sector. In Malawi, there was no legal mandate to regulate medical devices, in Zambia one regulatory body with a clear mandate had started developing regulations and in Zimbabwe the mandate to regulate was overlapping between two bodies. Stakeholders indicated that they had a poor understanding of the process and requirements for HIVST regulation, as well as lack of clarity and coordination between organizational roles. The need for good collaboration between sectors, a strong post-market surveillance model for HIVST and technical assistance to develop regulators capacity was noted as priorities. Key informants identified technical working groups as a potential way collaboration could be improved upon to accelerate the regulation of HIVST. CONCLUSION:Regulation of in vitro diagnostic devices, including HIVST, is now being recognized as important by regulators after a regional focus on pharmaceuticals. HIVST is providing an opportunity for each country to develop similar regulations to others in the region leading to a more coherent regulatory environment for the introduction of new devices.

Project description:BackgroundMalaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients.MethodsIn April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads.ResultsAt the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT.ConclusionsMalawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved.

Dataset Information

Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.

Publications

Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure