Recency of HIV infection, antiretroviral therapy use and viral loads among symptomatic sexually transmitted infection service attendees in South Africa

• Published in: South African medical journal Vol. 112; no. 2; pp. 96 - 101
• Main Authors: Kufa, T, Radebe, F, Cutler, E, Goosen, M, Wiesner, L, Greyling, D, Maseko, V, Kularatne, R, Puren, A
• Format: Journal Article
• Language: English
• Published: South Africa Health and Medical Publishing Group (HMPG) 01.02.2022; Health & Medical Publishing Group
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Antiviral agents; Cross-Sectional Studies; Drug therapy; Female; HIV infection; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; Male; Prevention; Sexually transmitted diseases; Sexually Transmitted Diseases - epidemiology; Sexually Transmitted Diseases - therapy; South Africa - epidemiology; Statistics; Surveys and Questionnaires; Viral Load; Young Adult; South Africa
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2022.v112i2.15930

Background Better integration of HIV and sexually transmitted infection (STI) prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections.Objectives To describe HIV positivity, antiretroviral therapy (ART) use, viral suppression and recency of HIV infection among symptomatic STI service attendees at two primary care clinics in South Africa.Methods In a cross-sectional study, male and female STI service attendees presenting with symptoms consistent with STI syndromes were enrolled following informed consent. An interviewer-administered questionnaire was completed and appropriate genital and blood specimens were collected for STI testing and HIV biomarker measurements including recency of infection and antiretroviral (ARV) drug levels. Descriptive statistics were used to describe enrolled attendees, and to determine the proportion of attendees who were HIV-positive, recently infected, taking ART and virally suppressed. HIV-positive attendees with detectable ARVs were considered to be on ART, while those with viral loads (VLs) ≤200 copies/mL were considered virally suppressed.Results Of 451 symptomatic attendees whose data were analysed, 93 (20.6%) were HIV-positive, with 15/93 (16.1%) being recently infected. Recent infection was independently associated with genital ulcer disease at presentation, especially ulcers with no detectable STI pathogens. Among the 78 (83.9%) with long-term infection, only 30 (38.5%) were on ART, with 23/30 (76.7%) virally suppressed.Conclusions In a population at risk of HIV transmission, there was a high burden of recent infection and unsuppressed VLs. Incorporating pre-exposure prophylaxis, ART initiation and adherence support into STI services will be necessary for progress towards eliminating HIV transmission.