@article{fdi:010065441,
  title = {{C}ascade of {HIV} care and population viral suppression in a high-burden region of {K}enya},
  author = {{M}aman, {D}. and {Z}eh, {C}. and {M}ukui, {I}. and {K}irubi, {B}. and {M}asson, {S}. and {O}polo, {V}. and {S}zumilin, {E}. and {R}iche, {B}. and {E}tard, {J}ean-{F}ran{\c{c}}ois},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction: {D}irect measurement of antiretroviral treatment ({ART}) program indicators essential for evidence-based planning and evaluation - especially {HIV} incidence, population viral load, and {ART} eligibility - is rare in sub-{S}aharan {A}frica. {D}esign/methods: {T}o measure key indicators in rural western {K}enya, an area with high {HIV} burden, we conducted a population survey in {S}eptember to {N}ovember 2012 via multistage cluster sampling, recruiting everyone aged 15-59 years living in 3330 randomly selected households. {C}onsenting individuals were interviewed and tested for {HIV} at home. {P}articipants testing positive were assessed for {CD}4(+) cell count and viral load, and their infections classified as either recent or long term based on {L}imiting {A}ntigen {A}vidity assays. {HIV}-negative participants were tested by nucleic acid amplification to detect acute infections. {R}esults: {O}f 6833 household members eligible for the study, 6076 (94.7% of all women and 81.0% of men) agreed to participate. {HIV} prevalence and incidence were 24.1% [95% confidence interval [{CI}] 23.0-25.2] and 1.9 new cases/100person-years (95% {CI} 1.1-2.7), respectively. {A}mong {HIV}-positive participants, 59.4% (95% {CI} 56.8-61.9) were previously diagnosed, 53.1% (95% {CI} 50.5-55.7) were receiving care, and 39.7% (95% {CI} 37.1-42.4) had viral load less than 1000copies/ml. {A}pplying 2013 {WHO} recommendations for {ART} initiation increased the proportion of {ART}-eligible people from 60.0% (based on national guidelines in place during the survey; 95% {CI} 57.3-62.7) to 82.0% (95% {CI} 79.5-84.5). {A}mong {HIV}-positive people not receiving {ART}, viral load increased with decreasing {CD}4(+) cell count (500-749 vs. 750cells/l, adjusted mean difference, 0.40log(10)copies/ml, 95% {CI} 0.20-0.60, {P}<0.01). {C}onclusion: {T}his study demonstrates how population-level data can help optimize {HIV} programs. {B}ased on these results, new regional programs are prioritizing diagnosis and expanding {ART} eligibility, key steps to reach undetectable viral load.},
  keywords = {cascade of care ; community viral load ; incidence ; population survey ; population viral load ; sub-{S}aharan {A}frica ; {KENYA}},
  booktitle = {},
  journal = {{A}ids},
  volume = {29},
  numero = {12},
  pages = {1557--1565},
  ISSN = {0269-9370},
  year = {2015},
  DOI = {10.1097/qad.0000000000000741},
  URL = {https://www.documentation.ird.fr/hor/fdi:010065441},
}