Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial
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. DESIGN:A community cluster randomized trial. METHODS:The SEARC...
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| Veröffentlicht in: | AIDS (London) 2020-07, Vol.34 (9), p.1407-1415 |
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| creator | Kabami, Jane Balzer, Laura B. Saddiki, Hachem Ayieko, James Kwarisiima, Dalsone Atukunda, Mucunguzi Charlebois, Edwin D. Clark, Tamara D. Koss, Catherine A. Ruel, Theodore Bukusi, Elizabeth A. Cohen, Craig R. Musoke, Phillipa Petersen, Maya L. Havlir, Diane V. Kamya, Moses R. Chamie, Gabriel |
| description | 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.
DESIGN:A community cluster randomized trial.
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 |
| doi_str_mv | 10.1097/QAD.0000000000002564 |
| format | Article |
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DESIGN:A community cluster randomized trial.
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.
RESULTS:At baseline, 92 and 93% of 15 to 45-year-old women tested for HIVHIV 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.
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.</description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000002564</identifier><identifier>PMID: 32472768</identifier><language>eng</language><publisher>England: Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adolescent ; Adult ; Anti-HIV Agents - therapeutic use ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral Therapy, Highly Active - methods ; Female ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV Infections - virology ; Humans ; Kenya - epidemiology ; Middle Aged ; Postpartum Period ; Pregnancy ; Pregnant Women ; Prevalence ; Uganda - epidemiology ; Viral Load - drug effects ; Viral Load - statistics & numerical data ; Young Adult</subject><ispartof>AIDS (London), 2020-07, Vol.34 (9), p.1407-1415</ispartof><rights>Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright © 2020 Wolters Kluwer Health, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4474-4c1f3c256ea30e9b9728b3073a5833315d16c7b74ddfd67f69c92182cb93d3d93</citedby><cites>FETCH-LOGICAL-c4474-4c1f3c256ea30e9b9728b3073a5833315d16c7b74ddfd67f69c92182cb93d3d93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32472768$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kabami, Jane</creatorcontrib><creatorcontrib>Balzer, Laura B.</creatorcontrib><creatorcontrib>Saddiki, Hachem</creatorcontrib><creatorcontrib>Ayieko, James</creatorcontrib><creatorcontrib>Kwarisiima, Dalsone</creatorcontrib><creatorcontrib>Atukunda, Mucunguzi</creatorcontrib><creatorcontrib>Charlebois, Edwin D.</creatorcontrib><creatorcontrib>Clark, Tamara D.</creatorcontrib><creatorcontrib>Koss, Catherine A.</creatorcontrib><creatorcontrib>Ruel, Theodore</creatorcontrib><creatorcontrib>Bukusi, Elizabeth A.</creatorcontrib><creatorcontrib>Cohen, Craig R.</creatorcontrib><creatorcontrib>Musoke, Phillipa</creatorcontrib><creatorcontrib>Petersen, Maya L.</creatorcontrib><creatorcontrib>Havlir, Diane V.</creatorcontrib><creatorcontrib>Kamya, Moses R.</creatorcontrib><creatorcontrib>Chamie, Gabriel</creatorcontrib><title>Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>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.
DESIGN:A community cluster randomized trial.
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.
RESULTS:At baseline, 92 and 93% of 15 to 45-year-old women tested for HIVHIV 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.
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral Therapy, Highly Active - methods</subject><subject>Female</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - virology</subject><subject>Humans</subject><subject>Kenya - epidemiology</subject><subject>Middle Aged</subject><subject>Postpartum Period</subject><subject>Pregnancy</subject><subject>Pregnant Women</subject><subject>Prevalence</subject><subject>Uganda - epidemiology</subject><subject>Viral Load - drug effects</subject><subject>Viral Load - statistics & numerical data</subject><subject>Young Adult</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkF1PwyAUhonRuDn9B8Zw6U0nXy3lcpmfyRI10euGtnTrpKUC3eK_F-00xgvlghNOnvcADwCnGE0xEvzicXY5RT8WiRO2B8aYcRrFMcf7YIxIIiJBORqBI-fWAYpRmh6CESWME56kY7B-MF2vpa9NG2m1URpuais1dH3XWeVc6EPZmHYJw3HZytZD2ZawM8530vq-gVvTqBbWAYN9W2-UdSHulRtAb5X0Ya-lPgYHldROnezqBDxfXz3Nb6PF_c3dfLaICsY4i1iBK1qE3yhJkRK54CTNKeJUximlFMclTgqec1aWVZnwKhGFIDglRS5oSUtBJ-B8mNtZ89qHh2RN7QqltWyV6V1GGEqxiCkhAWUDWljjnFVV1tm6kfYtwyj7sJwFy9lvyyF2truhzxtVfoe-tAYgHYCt0T4YedH9VtlspaT2q_9msz-inxiiKCKhII5jFIUOZvQdlceZoA</recordid><startdate>20200715</startdate><enddate>20200715</enddate><creator>Kabami, Jane</creator><creator>Balzer, Laura B.</creator><creator>Saddiki, Hachem</creator><creator>Ayieko, James</creator><creator>Kwarisiima, Dalsone</creator><creator>Atukunda, Mucunguzi</creator><creator>Charlebois, Edwin D.</creator><creator>Clark, Tamara D.</creator><creator>Koss, Catherine A.</creator><creator>Ruel, Theodore</creator><creator>Bukusi, Elizabeth A.</creator><creator>Cohen, Craig R.</creator><creator>Musoke, Phillipa</creator><creator>Petersen, Maya L.</creator><creator>Havlir, Diane V.</creator><creator>Kamya, Moses R.</creator><creator>Chamie, Gabriel</creator><general>Wolters Kluwer Health, Inc. All rights reserved</general><general>Copyright Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200715</creationdate><title>Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial</title><author>Kabami, Jane ; Balzer, Laura B. ; Saddiki, Hachem ; Ayieko, James ; Kwarisiima, Dalsone ; Atukunda, Mucunguzi ; Charlebois, Edwin D. ; Clark, Tamara D. ; Koss, Catherine A. ; Ruel, Theodore ; Bukusi, Elizabeth A. ; Cohen, Craig R. ; Musoke, Phillipa ; Petersen, Maya L. ; Havlir, Diane V. ; Kamya, Moses R. ; Chamie, Gabriel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4474-4c1f3c256ea30e9b9728b3073a5833315d16c7b74ddfd67f69c92182cb93d3d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Anti-Retroviral Agents - therapeutic use</topic><topic>Antiretroviral Therapy, Highly Active - methods</topic><topic>Female</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - virology</topic><topic>Humans</topic><topic>Kenya - epidemiology</topic><topic>Middle Aged</topic><topic>Postpartum Period</topic><topic>Pregnancy</topic><topic>Pregnant Women</topic><topic>Prevalence</topic><topic>Uganda - epidemiology</topic><topic>Viral Load - drug effects</topic><topic>Viral Load - statistics & numerical data</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kabami, Jane</creatorcontrib><creatorcontrib>Balzer, Laura B.</creatorcontrib><creatorcontrib>Saddiki, Hachem</creatorcontrib><creatorcontrib>Ayieko, James</creatorcontrib><creatorcontrib>Kwarisiima, Dalsone</creatorcontrib><creatorcontrib>Atukunda, Mucunguzi</creatorcontrib><creatorcontrib>Charlebois, Edwin D.</creatorcontrib><creatorcontrib>Clark, Tamara D.</creatorcontrib><creatorcontrib>Koss, Catherine A.</creatorcontrib><creatorcontrib>Ruel, Theodore</creatorcontrib><creatorcontrib>Bukusi, Elizabeth A.</creatorcontrib><creatorcontrib>Cohen, Craig R.</creatorcontrib><creatorcontrib>Musoke, Phillipa</creatorcontrib><creatorcontrib>Petersen, Maya L.</creatorcontrib><creatorcontrib>Havlir, Diane V.</creatorcontrib><creatorcontrib>Kamya, Moses R.</creatorcontrib><creatorcontrib>Chamie, Gabriel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kabami, Jane</au><au>Balzer, Laura B.</au><au>Saddiki, Hachem</au><au>Ayieko, James</au><au>Kwarisiima, Dalsone</au><au>Atukunda, Mucunguzi</au><au>Charlebois, Edwin D.</au><au>Clark, Tamara D.</au><au>Koss, Catherine A.</au><au>Ruel, Theodore</au><au>Bukusi, Elizabeth A.</au><au>Cohen, Craig R.</au><au>Musoke, Phillipa</au><au>Petersen, Maya L.</au><au>Havlir, Diane V.</au><au>Kamya, Moses R.</au><au>Chamie, Gabriel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2020-07-15</date><risdate>2020</risdate><volume>34</volume><issue>9</issue><spage>1407</spage><epage>1415</epage><pages>1407-1415</pages><issn>0269-9370</issn><eissn>1473-5571</eissn><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.
DESIGN:A community cluster randomized trial.
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.
RESULTS:At baseline, 92 and 93% of 15 to 45-year-old women tested for HIVHIV 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.
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.</abstract><cop>England</cop><pub>Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>32472768</pmid><doi>10.1097/QAD.0000000000002564</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | AIDS (London), 2020-07, Vol.34 (9), p.1407-1415 |
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| subjects | Adolescent Adult Anti-HIV Agents - therapeutic use Anti-Retroviral Agents - therapeutic use Antiretroviral Therapy, Highly Active - methods Female HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - virology Humans Kenya - epidemiology Middle Aged Postpartum Period Pregnancy Pregnant Women Prevalence Uganda - epidemiology Viral Load - drug effects Viral Load - statistics & numerical data Young Adult |
| title | Population-level viral suppression among pregnant and postpartum women in a universal test and treat trial |
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