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DC Field | Value | Language |
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dc.contributor.author | Ayieko, James | - |
dc.contributor.author | Sang, Norton | - |
dc.contributor.author | Kabami, Jane | - |
dc.contributor.author | A Bukusi, Elizabeth | - |
dc.date.accessioned | 2021-07-08T08:44:43Z | - |
dc.date.available | 2021-07-08T08:44:43Z | - |
dc.date.issued | 2017-06-06 | - |
dc.identifier.uri | http://ir.mu.ac.ke:8080/jspui/handle/123456789/4792 | - |
dc.description.abstract | IMPORTANCE Antiretroviral treatment (ART) is now recommended for all HIV-positive persons. UNAIDS has set global targets to diagnose 90% of HIV-positive individuals, treat 90% of diagnosed individuals with ART, and suppress viral replication among 90% of treated individuals, for a population-level target of 73%of all HIV-positive persons with HIV viral suppression. OBJECTIVE To describe changes in the proportions of HIV-positive individuals with HIV viral suppression, HIV-positive individuals who had received a diagnosis, diagnosed individuals treated with ART, and treated individuals with HIV viral suppression, following implementation of a community-based testing and treatment program in rural East Africa. DESIGN, SETTING, AND PARTICIPANTS Observational analysis based on interim data from 16 rural Kenyan (n = 6) and Ugandan (n = 10) intervention communities in the SEARCH Study, an ongoing cluster randomized trial. Community residents who were 15 years or older (N = 77 774) were followed up for 2 years (2013-2014 to 2015-2016). HIV serostatus and plasma HIV RNA level were measured annually at multidisease health campaigns followed by home-based testing for nonattendees. All HIV-positive individuals were offered ART using a streamlined delivery model designed to reduce structural barriers, improve patient-clinician relationships, and enhance patient knowledge and attitudes about HIV. MAIN OUTCOMES AND MEASURES Primary outcomewas viral suppression (plasma HIV RNA<500 copies/mL) among all HIV-positive individuals, assessed at baseline and after 1 and 2 years. Secondary outcomes included HIV diagnosis, ART among previously diagnosed individuals, and viral suppression among those who had initiated ART. RESULTS Among 77 774 residents (male, 45.3%; age 15-24 years, 35.1%), baseline HIV prevalence was 10.3%(7108 of 69 283 residents). The proportion of HIV-positive individuals with HIV viral suppression at baseline was 44.7%(95%CI, 43.5%-45.9%; 3464 of 7745 residents) and after 2 years of intervention was 80.2%(95%CI, 79.1%-81.2%; 5666 of 7068 residents), an increase of 35.5 percentage points (95%CI, 34.4-36.6). After 2 years, 95.9%of HIV-positive individuals had been previously diagnosed (95%CI, 95.3%-96.5%; 6780 of 7068 residents); 93.4%of those previously diagnosed had received ART (95%CI, 92.8%-94.0%; 6334 of 6780 residents); and 89.5%of those treated had achieved HIV viral suppression (95%CI, 88.6%-90.3%; 5666 of 6334 residents). CONCLUSIONS AND RELEVANCE Among individuals with HIV in rural Kenya andUganda, implementation of community-based testing and treatmentwas associated with an increased proportion of HIV-positive adults who achieved viral suppression, along with increased HIV diagnosis and initiation of antiretroviral therapy. In these communities, the UNAIDS populationlevel viral suppression targetwas exceeded within 2 years after programimplementation. | en_US |
dc.language.iso | en | en_US |
dc.publisher | American Medical Association | en_US |
dc.subject | Universal Testing | en_US |
dc.subject | HIV Diagnosis | en_US |
dc.subject | Antiretroviral Therapy | en_US |
dc.subject | viral suppression | en_US |
dc.title | Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antiretroviral therapy, and viral suppression in East Africa | en_US |
dc.type | Article | en_US |
Appears in Collections: | School of Education |
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jama_petersen_2017_oi_170049.pdf | 415.62 kB | Adobe PDF | View/Open |
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