Mohammad Zubair Harooni1, Abdul Alim Atarud1, Ehsanullah Ehsan2, Ajmal Alokozai2, Willi McFarland3, Ali Mirzazadeh3,4. 1. 198006United Nations Development Programme, Kabul, Afghanistan. 2. Ministry of Public Health, Kabul, Afghanistan. 3. Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, 254285University of California San Francisco, San Francisco, CA, USA. 4. HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Abstract
BACKGROUND: Afghanistan adopted a "test and treat" strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. METHODS: We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. RESULTS: Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35-44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. CONCLUSION: Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.
BACKGROUND: Afghanistan adopted a "test and treat" strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. METHODS: We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. RESULTS: Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35-44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. CONCLUSION: Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.
Entities:
Keywords:
Afghanistan; HIV infections; antiretroviral agents; continuity of patient care; viral load
Authors: Nima Ghalehkhani; Behnam Farhoudi; Mohammad Mehdi Gouya; Hamid Sharifi; SeyedAhmad SeyedAlinaghi; Kianoush Kamali; Noushin Fahimfar; Zahra Rajabpour; Amin Doosti-Irani; Abbas Sedaghat; Ali Mirzazadeh Journal: Int J STD AIDS Date: 2019-09-27 Impact factor: 1.359
Authors: John Weiser; John T Brooks; Jacek Skarbinski; Brady T West; Christopher C Duke; Garrett W Gremel; Linda Beer Journal: J Acquir Immune Defic Syndr Date: 2017-04-15 Impact factor: 3.731
Authors: Linda Beer; Eduardo E Valverde; Jerris L Raiford; John Weiser; Becky L White; Jacek Skarbinski Journal: J Int Assoc Provid AIDS Care Date: 2014-11-12
Authors: Behnam Farhoudi; Nima Ghalekhani; Parvin Afsar Kazerooni; Hengameh Namdari Tabar; Katayoun Tayeri; Mohammad Mehdi Gouya; SeyedAhmad SeyedAlinaghi; Ali Akbar Haghdoost; Ali Mirzazadeh; Hamid Sharifi Journal: AIDS Care Date: 2021-06-28
Authors: Kimberly Marsh; Jeffrey W Eaton; Mary Mahy; Keith Sabin; Christine S Autenrieth; Ian Wanyeki; Juliana Daher; Peter D Ghys Journal: AIDS Date: 2019-12-15 Impact factor: 4.177
Authors: Diane Havlir; Shahin Lockman; Helen Ayles; Joseph Larmarange; Gabriel Chamie; Tendani Gaolathe; Collins Iwuji; Sarah Fidler; Moses Kamya; Sian Floyd; Janet Moore; Richard Hayes; Maya Petersen; Francois Dabis Journal: J Int AIDS Soc Date: 2020-02 Impact factor: 5.396
Authors: Abdul Rasheed; Hamid Sharifi; Paul Wesson; Sayed Jalal Pashtoon; Fatemeh Tavakoli; Nima Ghalekhani; Ali Akbar Haghdoost; Alim Atarud; Mohammad Reza Banehsi; Naqibullah Hamdard; Said Iftekhar Sadaat; Willi McFarland; Ali Mirzazadeh Journal: PLoS One Date: 2022-01-28 Impact factor: 3.240