Progress towards the UNAIDS 90‐90‐90 targets among persons aged 50 and older living with HIV in 13 African countries
Introduction Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa...
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Published in | Journal of the International AIDS Society Vol. 25; no. S4; pp. e26005 - n/a |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Geneva
John Wiley & Sons, Inc
01.09.2022
John Wiley and Sons Inc |
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Abstract | Introduction
Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe).
Methods
Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata.
Results
Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum.
Conclusions
While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. |
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AbstractList | INTRODUCTIONAchieving optimal HIV outcomes, as measured by global 90-90-90 targets, that is awareness of HIV-positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub-Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90-90-90 progress by age, 15-49 (as a comparison) and 50+ years, with further analyses among 50+ (55-59, 60-64, 65+ vs. 50-54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). METHODSUsing data from nationally representative Population-based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90-90-90 targets. Country-specific Poisson regression models examined 90-90-90 variation among OPLWH age strata. RESULTSAnalyses included 24,826 HIV-positive individuals (15-49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15-49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15-49, women were more likely to achieve 90-90-90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country-specific 90-90-90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. CONCLUSIONSWhile OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV-positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata. Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. Abstract Introduction Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Methods Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata. Results Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. Conclusions While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. Introduction: Achieving optimal HIV outcomes, as measured by global 90?90?90 targets, that is awareness of HIV?positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub?Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90?90?90 progress by age, 15?49 (as a comparison) and 50+ years, with further analyses among 50+ (55?59, 60?64, 65+ vs. 50?54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Methods: Using data from nationally representative Population?based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90?90?90 targets. Country?specific Poisson regression models examined 90?90?90 variation among OPLWH age strata. Results: Analyses included 24,826 HIV?positive individuals (15?49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15?49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15?49, women were more likely to achieve 90?90?90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country?specific 90?90?90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. Conclusions: While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV?positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. Introduction Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Methods Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata. Results Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. Conclusions While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA. |
Audience | Academic |
Author | Chikwanda, Prisca El‐Sadr, Wafaa M. Mugurungi, Owen Getaneh, Yimam Low, Andrea Jane Aibo, Dorothy Kakishozi, Angela N. Voetsch, Andrew C. Kayigamba, Felix R. Asiimwe, Fred Justman, Jessica J. Ndagije, Felix Shang, Judith Musinguzi, Joshua Juma, James Hoos, David Nkurunziza, Peter Pietersen, Ismela Harris, Tiffany G. Wadonda, Nellie Nkumbula, Tepa Delgado, Stephen Tenthani, Lyson Aoko, Appolonia Balachandra, Shirish Moyo, Brian Kirungi, Wilford Kabala, Andrew Bissek, Anne‐Cecile Dimite, Laura E. Kancheya, Nzali Patel, Hetal K. Wang, Chunhui McCullough‐Sanden, Rachel Amuri, Mbaraka Ayite, Ayiyi Eshetu, Frehywot Sleeman, Katrina Natanael, Salomo Nyirenda, Rose Biraro, Sam Dokubo, Emily K. Musuka, Godfrey Mutenda, Nicholus Kayirangwa, Eugenie Farley, Shannon M. Bray, Rachel M. Bodika, Stephane Li, Michelle Lecher, Shirley Ward, Jennifer Brown, Kristin Ndongmo, Clement West, Christine A. Ngugi, Evelyn W. |
AuthorAffiliation | 19 CDC Addis Ababa Ethiopia 7 Ministry of Health Community Development Gender, Elderly and Children through The National AIDS Control Program (NACP) Dodoma Tanzania 9 CDC Windhoek Namibia 10 Ministry of Health and Social Services Windhoek Namibia 13 CDC Kampala Uganda 20 Uganda Ministry of Health Kampala Uganda 6 CDC Dar es Salaam Tanzania 14 CDC Harare Zimbabwe 18 Ethiopia Public Health Institute Addis Ababa Ethiopia 2 Department of Epidemiology Mailman School of Public Health Columbia University New York City New York USA 17 Cameroon Ministry of Public Health Yaounde Cameroon 22 CDC Kigali Rwanda 4 US Centers for Disease Control and Prevention (CDC) Lilongwe Malawi 16 CDC Yaounde Cameroon 5 CDC Mbabane Eswatini 21 CDC Abidjan Cote d'Ivoire 3 Malawi Ministry of Health Lilongwe Malawi 23 CDC Atlanta Georgia USA 8 CDC Lusaka Zambia 15 Zimbabwe Ministry of Health and Child Care Hararre Zimbabwe 12 CDC Maseru Lesotho 11 CDC Nairobi Kenya 1 ICAP at Columbia University New York City New York USA |
AuthorAffiliation_xml | – name: 9 CDC Windhoek Namibia – name: 10 Ministry of Health and Social Services Windhoek Namibia – name: 4 US Centers for Disease Control and Prevention (CDC) Lilongwe Malawi – name: 12 CDC Maseru Lesotho – name: 19 CDC Addis Ababa Ethiopia – name: 2 Department of Epidemiology Mailman School of Public Health Columbia University New York City New York USA – name: 18 Ethiopia Public Health Institute Addis Ababa Ethiopia – name: 6 CDC Dar es Salaam Tanzania – name: 17 Cameroon Ministry of Public Health Yaounde Cameroon – name: 13 CDC Kampala Uganda – name: 14 CDC Harare Zimbabwe – name: 8 CDC Lusaka Zambia – name: 15 Zimbabwe Ministry of Health and Child Care Hararre Zimbabwe – name: 20 Uganda Ministry of Health Kampala Uganda – name: 23 CDC Atlanta Georgia USA – name: 5 CDC Mbabane Eswatini – name: 11 CDC Nairobi Kenya – name: 21 CDC Abidjan Cote d'Ivoire – name: 1 ICAP at Columbia University New York City New York USA – name: 7 Ministry of Health Community Development Gender, Elderly and Children through The National AIDS Control Program (NACP) Dodoma Tanzania – name: 22 CDC Kigali Rwanda – name: 16 CDC Yaounde Cameroon – name: 3 Malawi Ministry of Health Lilongwe Malawi |
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gux5@cdc.gov organization: CDC – sequence: 22 givenname: Jennifer surname: Ward fullname: Ward, Jennifer email: vzx5@cdc.gov organization: CDC – sequence: 23 givenname: Prisca surname: Chikwanda fullname: Chikwanda, Prisca email: ooj8@cdc.gov organization: CDC – sequence: 24 givenname: Owen surname: Mugurungi fullname: Mugurungi, Owen email: mugurungi@gmail.com organization: Zimbabwe Ministry of Health and Child Care – sequence: 25 givenname: Brian surname: Moyo fullname: Moyo, Brian email: moyobk1@gmail.com organization: Zimbabwe Ministry of Health and Child Care – sequence: 26 givenname: Peter surname: Nkurunziza fullname: Nkurunziza, Peter email: pn2289@cumc.columbia.edu organization: ICAP at Columbia University – sequence: 27 givenname: Dorothy surname: Aibo fullname: Aibo, Dorothy email: dae2131@cumc.columbia.edu organization: ICAP at Columbia University – sequence: 28 givenname: Andrew surname: Kabala fullname: Kabala, Andrew email: ak3969@cumc.columbia.edul organization: ICAP at 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ContentType | Journal Article |
Copyright | 2022 The Authors. published by John Wiley & Sons Ltd on behalf of the International AIDS Society. COPYRIGHT 2022 John Wiley & Sons, Inc. 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
Copyright_xml | – notice: 2022 The Authors. published by John Wiley & Sons Ltd on behalf of the International AIDS Society. – notice: COPYRIGHT 2022 John Wiley & Sons, Inc. – notice: 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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DOI | 10.1002/jia2.26005 |
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Snippet | Introduction
Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV)... Abstract Introduction Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of... Introduction: Achieving optimal HIV outcomes, as measured by global 90?90?90 targets, that is awareness of HIV?positive status, receipt of antiretroviral (ARV)... Introduction: Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV)... Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among... IntroductionAchieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV)... INTRODUCTIONAchieving optimal HIV outcomes, as measured by global 90-90-90 targets, that is awareness of HIV-positive status, receipt of antiretroviral (ARV)... |
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SubjectTerms | Acquired immune deficiency syndrome Age groups ageing AIDS AIDS (Disease) AIDS research Antiretroviral agents Care and treatment Demographic aspects Demographics Evaluation Health status indicators HIV HIV epidemiology HIV infection HIV testing Households Human immunodeficiency virus Laboratories Older people older PLHIV PHIA Population Public health administration Self report UNAIDS goals Women |
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Title | Progress towards the UNAIDS 90‐90‐90 targets among persons aged 50 and older living with HIV in 13 African countries |
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