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Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial.
- Source :
-
AIDS (London, England) [AIDS] 2020 Jul 15; Vol. 34 (9), pp. 1407-1415. - Publication Year :
- 2020
-
Abstract
- Objective(s): We sought to determine whether universal 'test and treat' (UTT) can achieve gains in viral suppression beyond universal antiretroviral treatment (ART) eligibility during pregnancy and postpartum, among women living with HIV.<br />Design: A community cluster randomized trial.<br />Methods: The SEARCH UTT trial compared an intervention of annual population testing and universal ART with a control of baseline population testing with ART by country standard, including ART eligibility for all pregnant/postpartum women, in 32 communities in Kenya and Uganda. When testing, women were asked about current pregnancy and live births over the prior year and, if HIV-infected, had their viral load measured. Between arms, we compared population-level viral suppression (HIV RNA <500 copies/ml) among all pregnant/postpartum HIV-infected women at study close (year 3). We also compared year-3 population-level viral suppression and predictors of viral suppression among all 15 to 45-year-old women by arm.<br />Results: At baseline, 92 and 93% of 15 to 45-year-old women tested for HIV: HIV prevalence was 12.6 and 12.3%, in intervention and control communities, respectively. Among HIV-infected women self-reporting pregnancy/live birth, prevalence of viral suppression was 42 and 44% at baseline, and 81 and 76% (P = 0.02) at year 3, respectively. Among all 15 to 45-year-old HIV-infected women, year-3 population-level viral suppression was higher in intervention (77%) versus control (68%; P < 0.001). Pregnancy/live birth was a predictor of year-3 viral suppression in control (P = 0.016) but not intervention (P = 0.43). Younger age was a risk factor for nonsuppression in both arms.<br />Conclusion: The SEARCH intervention resulted in higher population viral suppression among pregnant/postpartum women than a control of baseline universal testing with ART eligibility for pregnant/postpartum women.
- Subjects :
- Adolescent
Adult
Anti-Retroviral Agents therapeutic use
Female
HIV Infections epidemiology
HIV Infections virology
Humans
Kenya epidemiology
Middle Aged
Postpartum Period
Pregnancy
Pregnant Women
Prevalence
Uganda epidemiology
Viral Load statistics & numerical data
Young Adult
Anti-HIV Agents therapeutic use
Antiretroviral Therapy, Highly Active methods
HIV Infections drug therapy
Viral Load drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5571
- Volume :
- 34
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- AIDS (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 32472768
- Full Text :
- https://doi.org/10.1097/QAD.0000000000002564