Andrea Low1,2, Chloe Teasdale1,2,3, Kristin Brown4, Danielle T Barradas5, Owen Mugurungi6, Karam Sachathep1, Harriet Nuwagaba-Biribonwoha1,2, Sehin Birhanu4, Andrew Banda7, Koen Frederix1, Danielle Payne8, Elizabeth Radin1,2, Lubbe Wiesner9, Choice Ginindza10, Neena Philip1,2, Godfrey Musuka1, Sakhile Sithole1, Hetal Patel4, Limpho Maile11, Elaine J Abrams1,2,12, Stephen Arpadi1,2,12. 1. ICAP at Columbia, Mailman School of Public Health, New York, New York, USA. 2. Department of Epidemiology, Mailman School of Public Health, New York, USA. 3. Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA. 4. US Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 5. US Centers for Disease Control and Prevention, Lusaka, Zambia. 6. Ministry of Health and Child Welfare, AIDS and TB Programme, Harare, Zimbabwe. 7. Ministry of Health, Lusaka, Zambia. 8. US Centers for Disease Control and Prevention, Lilongwe, Malawi. 9. Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa. 10. Eswatini Central Statistical Office, Mbabane, Eswatini. 11. Ministry of Health, Maseru, Lesotho. 12. Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Abstract
BACKGROUND: Adolescents aged 10-19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015-2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. METHODS: Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. RESULTS: HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%-66.6%) had HIV previously diagnosed, and 47.1% (41.9%-52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. CONCLUSIONS: These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.
BACKGROUND: Adolescents aged 10-19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015-2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. METHODS: Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. RESULTS:HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%-66.6%) had HIV previously diagnosed, and 47.1% (41.9%-52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. CONCLUSIONS: These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.