Joseph Larmarange

Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa

Joseph LARMARANGE — 2023-07-20T11:00:49Z

Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa

Joseph Larmarange , Pamela Bachanas , Timothy Skalland , Laura Balzer , Collins Iwuji , Sian Floyd , Lisa Mills , Deenan Pillay , Diane Havlir , Moses Kamya , Helen Ayles , Kathleen Wirth , François Dabis , Richard Hayes , Maya Petersen

PLOS Global Public Health, 2023, 3 (7), pp.e0002157. ⟨10.1371/journal.pgph.0002157⟩

Article dans une revue

hal-04166971

Authors

Joseph Larmarange, Pamela Bachanas, Timothy Skalland, Laura B. Balzer, Collins Iwuji, Sian Floyd, Lisa A. Mills, Deenan Pillay, Diane Havlir, Moses R. Kamya, Helen Ayles, Kathleen Wirth, François Dabis, Richard Hayes, Maya Petersen, for the UT³C consortium

Abstract

Universal HIV testing and treatment (UTT) strategies aim to optimize population-level benefits of antiretroviral treatment. Between 2012 and 2018, four large community randomized trials were conducted in eastern and southern Africa. While their results were broadly consistent showing decreased population-level viremia reduces HIV incidence, it remains unclear how much HIV incidence can be reduced by increasing suppression among people living with HIV (PLHIV).

We conducted a pooled analysis across the four UTT trials. Leveraging data from 105 communities in five countries, we evaluated the linear relationship between i) population-level viremia (prevalence of non-suppression–defined as plasma HIV RNA >500 or >400 copies/mL–among all adults, irrespective of HIV status) and HIV incidence; and ii) prevalence of non-suppression among PLHIV and HIV incidence, using parametric g-computation.

HIV prevalence, measured in 257 929 persons, varied from 2 to 41% across the communities; prevalence of non-suppression among PLHIV, measured in 31 377 persons, from 3 to 70%; population-level viremia, derived from HIV prevalence and non-suppression, from < 1% to 25%; and HIV incidence, measured over 345 844 person-years (PY), from 0.03/100PY to 3.46/100PY.

Decreases in population-level viremia were strongly associated with decreased HIV incidence in all trials (between 0.45/100PY and 1.88/100PY decline in HIV incidence per 10 percentage points decline in viremia). Decreases in non-suppression among PLHIV were also associated with decreased HIV incidence in all trials (between 0.06/100PY and 0.17/100PY decline in HIV incidence per 10 percentage points decline in non-suppression).

Our results support both the utility of population-level viremia as a predictor of incidence, and thus a tool for targeting prevention interventions, and the ability of UTT approaches to reduce HIV incidence by increasing viral suppression. Implementation of universal HIV testing approaches, coupled with interventions to leverage linkage to treatment, adapted to local contexts, can reduce HIV acquisition at population level.

Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial)

Joseph LARMARANGE — 2023-01-21T11:06:43Z

Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial)

Mélanie Plazy , Adama Diallo , Thabile Hlabisa , Nonhlanhla Okesola , Collins Iwuji , Kobus Herbst , Sylvie Boyer , France Lert , Nuala Mcgrath , Deenan Pillay , François Dabis , Joseph Larmarange , Joanna Orne-Gliemann

PLoS ONE, 2023, 18 (1), ⟨10.1371/journal.pone.0280479⟩

Article dans une revue

ird-03950125

Authors

Mélanie Plazy, Adama Diallo, Thabile Hlabisa, Nonhlanhla Okesola, Collins Iwuji, Kobus Herbst, Sylvie Boyer, France Lert, Nuala McGrath, Deenan Pillay, François Dabis, Joseph Larmarange, Joanna Orne-Gliemann, for the ANRS TasP Study Group

Abstract

Background

Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa.

Methods

In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012–2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to “re-refer” people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up.

Results

Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47–2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07–7.48).

Conclusions

Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.

Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa

Joseph LARMARANGE — 2022-12-18T12:26:51Z

Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa

K. Sabapathy , L. Balzer , Joseph Larmarange , L. Block , S. Floyd , C. Iwuji , K. Wirth , H. Ayles , S. Fidler , M. Kamya , M. Petersen , D. Havlir , F. Dabis , J. Moore , R. Hayes

BMC Public Health, 2022, 22 (1), pp.2333. ⟨10.1186/s12889-022-14713-5⟩

Article dans une revue

ird-03905396

Authors

K. Sabapathy, L. Balzer, J. Larmarange, L. Block, S. Floyd, C. Iwuji, K. Wirth, H. Ayles, S. Fidler, M. Kamya, M. Petersen, D. Havlir, F. Dabis, J. Moore & R. Hayes

Abstract

Background
Four large community-randomized trials examining universal testing and treatment (UTT) to reduce HIV transmission were conducted between 2012–2018 in Botswana, Kenya, Uganda, Zambia and South Africa. In 2014, the UNAIDS 90–90-90 targets were adopted as a useful metric to monitor coverage. We systematically review the approaches used by the trials to measure intervention delivery, and estimate coverage against the 90–90-90 targets. We aim to provide in-depth understanding of the background contexts and complexities that affect estimation of population-level coverage related to the 90–90-90 targets.

Methods
Estimates were based predominantly on “process” data obtained during delivery of the interventions which included a combination of home-based and community-based services. Cascade coverage data included routine electronic health records, self-reported data, survey data, and active ascertainment of HIV viral load measurements in the field.

Results
The estimated total adult populations of trial intervention communities included in this study ranged from 4,290 (TasP) to 142,250 (Zambian PopART Arm-B). The estimated total numbers of PLHIV ranged from 1,283 (TasP) to 20,541 (Zambian PopART Arm-B). By the end of intervention delivery, the first-90 target (knowledge of HIV status among all PLHIV) was met by all the trials (89.2%-94.0%). Three of the four trials also achieved the second- and third-90 targets, and viral suppression in BCPP and SEARCH exceeded the UNAIDS target of 73%, while viral suppression in the Zambian PopART Arm-A and B communities was within a small margin ( 3%) of the target.

Conclusions
All four UTT trials aimed to implement wide-scale testing and treatment for HIV prevention at population level and showed substantial increases in testing and treatment for HIV in the intervention communities. This study has not uncovered any one estimation approach which is superior, rather that several approaches are available and researchers or policy makers seeking to measure coverage should reflect on background contexts and complexities that affect estimation of population-level coverage in their specific settings.

All four trials surpassed UNAIDS targets for universal testing in their intervention communities ahead of the 2020 milestone. All but one of the trials also achieved the 90–90 targets for treatment and viral suppression. UTT is a realistic option to achieve 95–95-95 by 2030 and fast-track the end of the HIV epidemic.

Décrire les épidémies, Comprendre les populations : une démographie du VIH en Afrique subsaharienne

Joseph LARMARANGE — 2022-10-14T06:38:12Z

Habilitation à Diriger des Recherches soutenue le 12 octobre 2012 par Joseph Larmarange à l'Université Paris Cité.
Décrire les épidémies, Comprendre les populations : une démographie du VIH en Afrique subsaharienne
Joseph Larmarange Démographie. Université Paris Cité, 2022 HDR tel-03814024

- Publications / Afrique subsaharienne, ATLAS, CAP-CoV-Soignants-BF, DOD-CI (ANRS 12287 / 12323), ELIHoS (ANRS 12139), PrEP CI (ANRS 12361), Prévalences du VIH (ANRS 12114), prevR, PRINCESSE, TasP (ANRS 12249), Afrique du Sud, Burkina Faso, Côte d'Ivoire, Mali, Sénégal, Accès aux soins, Analyse de séquences, Approches biographiques, Approches communautaires, Autotests VIH, Cartographie, Cascade des soins, Comparaison de cohortes, Comportements sexuels, Démographie, Dépistage, EDS (Enquêtes Démographiques et de Santé), Enquêtes par téléphone, Enseignement académique, Lien vers les soins, Épidémiologie, Essais cliniques, Estimateurs à noyau (kernel density estimation), Femmes enceintes, Financement des programmes, Hépatites virales, Homo / Bisexualités, Identités sexuelles, Incidence du VIH, Interpolation spatiale, IST (Infections Sexuellement Transmissibles), Itinéraires thérapeutiques, Masculinités, Ménages, Mesure d'impact, Mesure des indicateurs, Méthodologie, Migrations, Observatoire de population, Partenaires sexuel(le)s, PrEP, Prévalence du VIH, Prévention, Prise en charge, Recherche interventionnelle, Recherche participative/communautaire, Recrutement « boules de neige », Représentations / Perceptions, Représentativité et Biais, Santé publique, Santé sexuelle, Structure des populations, Structures de santé, Surveillance sentinelle, Téléphones mobiles, Temporalités, Traitement antirétroviral (ARV), Travail du sexe, Treatment as Prevention (TasP), Universal Test & Treat (UTT), Usageres de drogue, VIH / SIDA

Atteindre les populations périphériques en Afrique de l'Ouest : autodépistage du VIH et distribution secondaire

Joseph LARMARANGE — 2022-06-24T14:30:37Z

Interview dans le Bulletin du Collège de Liaison des Internes de Santé Publique de juin 2022, à l'occasion du Congrès National des Internes de Santé Publique.
Propos recueillis par Fabiana Cazzorla (ISP à Grenoble) avec l'aide de Bérenger Thomas et Audrey Geoffroy (ISP à Paris). Référence
Larmarange Joseph (2022) « Atteindre les populations périphériques en Afrique de l'Ouest : autodépistage du VIH et distribution secondaire »Fabiana Cazzorla, Bulletin du CLiSP #47. (…)

- Divers / Afrique subsaharienne, Côte d'Ivoire, Mali, Sénégal, ATLAS, PRINCESSE, TasP (ANRS 12249), Autotests VIH, Dépistage, PrEP, Prévention, Recherche interventionnelle, Recherche participative/communautaire, Santé publique, Santé sexuelle, Travail du sexe, Universal Test & Treat (UTT), VIH / SIDA

Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 treatment as prevention trial in South Africa

Joseph LARMARANGE — 2022-06-07T15:37:49Z

Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 treatment as prevention trial in South Africa

Marwân-Al-Qays Bousmah , Collins Iwuji , Nonhlanhla Okesola , Joanna Orne-Gliemann , Deenan Pillay , François Dabis , Joseph Larmarange , Sylvie Boyer

Social Science and Medicine, 2022, 305, pp.115068. ⟨10.1016/j.socscimed.2022.115068⟩

Article dans une revue

hal-03701276

Authors

Marwân-al-Qays Bousmah, Collins Iwuji, Nonhlanhla Okesola, Joanna Orne-Gliemann, Deenan Pillay, François Dabis, Joseph Larmarange, Sylvie Boyer for the ANRS 12249 TasP Study Group

Abstract

Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012–2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality – measured as the proportion of HIV tests performed among all contacts eligible for an HIV test – on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale.

Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial

Joseph LARMARANGE — 2022-02-26T17:58:40Z

Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial

Kathy Baisley , Joanna Orne‐gliemann , Joseph Larmarange , Mélanie Plazy , Dami Collier , Jaco Dreyer , Thobeka Mngomezulu , Kobus Herbst , Willem Hanekom , François Dabis , Mark J Siedner , Collins Iwuji

HIV Medicine, 2022, 23 (8), pp.922-928. ⟨10.1111/hiv.13263⟩

Article dans une revue

hal-03610156

Authors

Kathy Baisley, Joanna Orne-Gliemann, Joseph Larmarange, Mélanie Plazy, Dami Collier, Jaco Dreyer, Thobeka Mngomezulu, Kobus Herbst, Willem Hanekom, Francois Dabis, Mark J. Siedner, Collins Iwuji

Abstract

Objectives

Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits.

Methods

The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial.

Results

Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85–1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28–0.85, p = 0.01), but not after the trial ended.

Conclusions

The ‘treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.

Long-term survival among people living with HIV in rural South Africa: results from 6 years of observation in the ANRS 12249 treatment as prevention trial

Joseph LARMARANGE — 2021-07-19T09:00:00Z

Long-term survival among people living with HIV in rural South Africa: results from 6 years of observation in the ANRS 12249 treatment as prevention trial

Kathy Baisley , Joanna Orne-Gliemann , Joseph Larmarange , Mélanie Plazy , Dami Collier , Jaco Dreyer , T Mngomezulu , Kobus Herbst , W Hanekom , François Dabis , Mark Siedner , Collins Iwuji

11th IAS Conference on HIV Science (IAS 2021), Jul 2021, Berlin, Germany

Poster de conférence

hal-04121468

Authors

C. Iwuji, K. Baisley, J. orne-Gliemann, J. Larmarange, M. Plazy, D. Collier, J. Dreyer, T. Mngomezulu, K. Herbst, W. Hanekom, F. Dabis, M. Siedner

Abstract

BACKGROUND: Universal test-and-treat trials increased population-level virological suppression across trial sites in sub-Saharan Africa. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits.

METHODS: The TasP trial was a cluster-randomised trial implemented in 22 communities in rural South Africa, from 2012'2016. Households were offered six-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered in trial clinics to all people living with HIV (PLHIV) in the intervention clusters and according to national guidelines in the control clusters. At trial end, individuals attending the intervention clinics were transferred to the public ART programme, with a 'treat-all' strategy adopted in September 2016. Deaths during and two years after trial end were ascertained through annual demographic surveillance. Random effects Poisson regression was used to estimate rate ratios (RR) and 95%CI for the effect of trial arm on mortality among i) all PLHIV regardless of serostatus awareness, ii) PLHIV aware of their status, iii) those not on ART at entry to trial clinics. An interaction term between period and treatment arm was included, to allow the effect of trial arm to differ between periods.

RESULTS: Amongst all PLHIV and those aware of their serostatus, there was no effect of immediate ART on mortality (Table). Among individuals who started ART during the trial, there was evidence that the intervention decreased mortality (aRR=0.69, 95%CI=0.45-1.04, p=0.08), although the effect was primarily during the trial (aRR=0.49, 95%CI=0.28-0.85, p=0.01), but not after the trial ended (aRR=1.15, 95%CI=0.59-2.21, p=0.69).

CONCLUSIONS: The 'treat-all' strategy resulted in a mortality benefit amongst individuals who started ART within the trial but not in all PLHIV over 6 years of follow-up. To achieve maximum benefit of immediate ART in South Africa, barriers to ART uptake and retention in care need to be addressed.

Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial)

Joseph LARMARANGE — 2020-11-23T16:47:41Z

Authors

Marion Fiorentino, Marie Nishimwe, Camelia Protopopescu, Collins Iwuji, Nonhlanhla Okesola, Bruno Spire, Joanna Orne-Gliemann, Nuala McGrath, Deenan Pillay, François Dabis, Joseph Larmarange, Sylvie Boyer & for the ANRS 12249 TaSP Study Group

Abstract

We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm³ at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.

Reference

Fiorentino Marion, Nishimwe Marie, Protopopescu Camelia, Iwuji Collins, Okesola Nonhlanhla, Spire Bruno, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Larmarange Joseph, Boyer Sylvie and for the ANRS 12249 TaSP Study Group (2021) “Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial)”, AIDS and Behavior, 25 (4) (April), p. 1306-1322. DOI : 10.1007/s10461-020-03101-y. https://doi.org/10.1007/s10461-020-03101-y.

Population-level Viremia Predicts HIV Incidence across the Universal Test and Treat Studies

Joseph LARMARANGE — 2020-03-19T11:06:07Z

Oral communication virtually presented at CROI 2020 the 9^th of March 2020

Authors

Maya Petersen, Joseph Larmarange, Kathleen Wirth, Timothy Skalland, Helen Ayles, Moses Kamya, Shahin Lockman, Collins Iwuji, François Dabis, Joseph Makhema, Diane Havlir, Sian Floyd, Richard Hayes for the UT3C Consortium

Abstract

Improved understanding of the extent to which increased population-level viral suppression will reduce HIV incidence is needed. Using data from four large Universal Test and Treat Trials, we evaluated the relationship between viremia and incidence and its consistency across epidemic contexts.

We analyzed data from 105 communities in the PopART (21 communities in South Africa and Zambia, 25,000 adults each), BCPP (30 communities in Botswana, 3,600 adults each), ANRS 12249 TasP (22 communities in South Africa, 1,300 adults each) and SEARCH (32 communities in Uganda and Kenya, 5,000 adults each) studies. Communities ranged from rural to urban and varied in the mobility of their populations and their sex ratio ( 30% to 50% male). HIV incidence was measured via repeat testing between 2012-2018. Population viremia – % of all adults (HIV+ or HIV-) with HIV viremia – was estimated at midpoint of follow-up based on HIV prevalence and non-suppression among HIV+, with adjustment for differences between the measurement cohort and underlying population. Community-level regression, adjusted for study, was used to quantify the association between HIV incidence and viremia and to evaluate cross-study heterogeneity.

HIV prevalence (measured in 257,929 total persons, PopART: 37,006; BCPP: 12,570; TasP: 20,978; SEARCH: 187,375), ranged from 2% to 40% by community. Non-suppression among HIV+ (measured in 39,928 persons, PopART: 6,233; BCPP: 2,318; TasP: 6,617; SEARCH: 16,209) ranged from 3% to 70%. HIV incidence (measured over 345,844 person-years, PopART: 39,702; BCPP: 8,551; TasP: 26,832; SEARCH: 270,759) ranged from 0.03 to 3.4 per 100PY. Population-level viremia was strongly associated with HIV incidence; pooling across studies, HIV incidence decreased by 0.07/100PY (95% CI: 0.05,0.10, p<0.001) for each 1% absolute decrease in viremia. Incidence was significantly associated with viremia in each study; however, both strength of the incidence-viremia relationship (slope) and projected incidence at 0% viremia (intercept) differed (Figure).

Lower population-level HIV viremia was associated with lower HIV incidence in all four Universal Test and Treat Studies, conducted in a wide range of epidemic contexts in sub-Saharan Africa. Differences in external infection rate (due to variation in community size, mobility, and sex ratio) may have contributed to heterogeneity between studies.

Reference

Petersen Maya, Larmarange Joseph, Wirth Kathleen E, Skalland Timothy, Ayles Helen, Kamya Moses, Lockman Shahin, Iwuji Collins, Dabis François, Makhema Joseph, Havlir Diane, Floyd Sian, Hayes Richard and UT3C Consortium (2020) “Population-level Viremia Predicts HIV Incidence across the Universal Test and Treat Studies” (communication orale), presented at the Conference on Retroviruses and Opportunitic Infections (CROI), Boston. http://www.croiconference.org/sessions/population-level-viremia-predicts-hiv-incidence-across-universal-test-treat-studies.