PLoS ONE (Jan 2023)

The epidemiology of HIV population viral load in twelve sub-Saharan African countries

  • Wolfgang Hladik,
  • Paul Stupp,
  • Stephen D. McCracken,
  • Jessica Justman,
  • Clement Ndongmo,
  • Judith Shang,
  • Emily K. Dokubo,
  • Elizabeth Gummerson,
  • Isabelle Koui,
  • Stephane Bodika,
  • Roger Lobognon,
  • Hermann Brou,
  • Caroline Ryan,
  • Kristin Brown,
  • Harriet Nuwagaba-Biribonwoha,
  • Leonard Kingwara,
  • Peter Young,
  • Megan Bronson,
  • Duncan Chege,
  • Optatus Malewo,
  • Yohannes Mengistu,
  • Frederix Koen,
  • Andreas Jahn,
  • Andrew Auld,
  • Sasi Jonnalagadda,
  • Elizabeth Radin,
  • Ndapewa Hamunime,
  • Daniel B. Williams,
  • Eugenie Kayirangwa,
  • Veronicah Mugisha,
  • Rennatus Mdodo,
  • Stephen Delgado,
  • Wilford Kirungi,
  • Lisa Nelson,
  • Christine West,
  • Samuel Biraro,
  • Kumbutso Dzekedzeke,
  • Danielle Barradas,
  • Owen Mugurungi,
  • Shirish Balachandra,
  • Peter H. Kilmarx,
  • Godfrey Musuka,
  • Hetal Patel,
  • Bharat Parekh,
  • Katrina Sleeman,
  • Robert A. Domaoal,
  • George Rutherford,
  • Tsietso Motsoane,
  • Anne-Cécile Zoung-Kanyi Bissek,
  • Mansoor Farahani,
  • Andrew C. Voetsch

Journal volume & issue
Vol. 18, no. 6

Abstract

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Background We examined the epidemiology and transmission potential of HIV population viral load (VL) in 12 sub-Saharan African countries. Methods We analyzed data from Population-based HIV Impact Assessments (PHIAs), large national household-based surveys conducted between 2015 and 2019 in Cameroon, Cote d’Ivoire, Eswatini, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Blood-based biomarkers included HIV serology, recency of HIV infection, and VL. We estimated the number of people living with HIV (PLHIV) with suppressed viral load (Results The proportion of female PLHIV with viral suppression was higher than that among males in all countries, however, the number of unsuppressed females outnumbered that of unsuppressed males in all countries due to higher overall female HIV prevalence, with ratios ranging from 1.08 to 2.10 (median: 1.43). The spatial distribution of HIV seroprevalence, viremia prevalence, and number of unsuppressed adults often differed substantially within the same countries. The 1% and 5% of PLHIV with the highest VL on average accounted for 34% and 66%, respectively, of countries’ total VL. HIV transmission ratios varied widely across countries and were higher for male-to-female (range: 2.3–28.3/100 PY) than for female-to-male transmission (range: 1.5–10.6/100 PY). In all countries mean log10 VL among unsuppressed males was higher than that among females. Correlations between VL measures and incident HIV varied, were weaker for VL metrics among females compared to males and were strongest for the number of unsuppressed PLHIV per 100 HIV-negative adults (R2 = 0.92). Conclusions Despite higher proportions of viral suppression, female unsuppressed PLHIV outnumbered males in all countries examined. Unsuppressed male PLHIV have consistently higher VL and a higher risk of transmitting HIV than females. Just 5% of PLHIV account for almost two-thirds of countries’ total VL. Population-level VL metrics help monitor the epidemic and highlight key programmatic gaps in these African countries.