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Reviews of "Age and Gender Profiles of HIV Infection Burden and Viraemia: Novel Metrics for HIV Epidemic Control in African Populations with High Antiretroviral Therapy Coverage"

Reviewers: W Hladik (CDC) | 📘📘📘📘📘 • G Chamie (UCSF) | 📘📘📘📘📘

Published onJun 13, 2024
Reviews of "Age and Gender Profiles of HIV Infection Burden and Viraemia: Novel Metrics for HIV Epidemic Control in African Populations with High Antiretroviral Therapy Coverage"
key-enterThis Pub is a Review of
Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage
Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage
Description

Abstract Introduction To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which HIV viraemia is concentrating.Methods We analysed HIV testing and viral load data collected between 2013-2019 from the open, population-based Rakai Community Cohort Study (RCCS) in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, one-year age bands and residence in inland and fishing communities. All estimates were standardized to the underlying source population using census data. We then assessed 95-95-95 targets in their ability to identify the populations in which viraemia concentrates.Results Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%-5.3%) in 2013 to 1.9% (1.7%-2.2%) in 2019 in inland communities and from 19.1% (18.0%-20.4%) in 2013 to 4.7% (4.0%-5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95-95-95 targets. Instead, in both inland and fishing communities, women aged 25-29 and men aged 30-34 were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or had already achieved 95-95-95 targets.Conclusions The 95-95-95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.

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Summary of Reviews: The reviewers commend the study for its comprehensive analysis of HIV prevalence and viremia in Ugandan communities, emphasizing that the UNAIDS 95-95-95 targets alone are insufficient to understand and address HIV transmission risks fully. They highlight that the study effectively demonstrates the importance of considering both viral load suppression and HIV prevalence to identify population viremia better and inform HIV control strategies. One reviewer suggests a more precise description of HIV incidence estimates and their correlation with population viremia. At the same time, the other recommends including the proportion of census-enumerated adults reached in each survey round. Reviewers emphasize the study’s valuable insights for informing targeted public health interventions and policies.

Reviewer 1 (Wolfgang U…) | 📘📘📘📘📘

Reviewer 2 (Gabriel C…) | 📘📘📘📘📘

RR:C19 Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

To read the reviews, click the links below. 

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