%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Maman, D.
%A Zeh, C.
%A Mukui, I.
%A Kirubi, B.
%A Masson, S.
%A Opolo, V.
%A Szumilin, E.
%A Riche, B.
%A Etard, Jean-François
%T Cascade of HIV care and population viral suppression in a high-burden region of Kenya
%D 2015
%L fdi:010065441
%G ENG
%J Aids
%@ 0269-9370
%K cascade of care ; community viral load ; incidence ; population survey ; population viral load ; sub-Saharan Africa
%K KENYA
%M ISI:000364395600002
%N 12
%P 1557-1565
%R 10.1097/qad.0000000000000741
%U https://www.documentation.ird.fr/hor/fdi:010065441
%> https://www.documentation.ird.fr/intranet/publi/2015/12/010065441.pdf
%V 29
%W Horizon (IRD)
%X Introduction: Direct 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-Saharan Africa. Design/methods: To measure key indicators in rural western Kenya, an area with high HIV burden, we conducted a population survey in September to November 2012 via multistage cluster sampling, recruiting everyone aged 15-59 years living in 3330 randomly selected households. Consenting individuals were interviewed and tested for HIV at home. Participants testing positive were assessed for CD4(+) cell count and viral load, and their infections classified as either recent or long term based on Limiting Antigen Avidity assays. HIV-negative participants were tested by nucleic acid amplification to detect acute infections. Results: Of 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. Among 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. Applying 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). Among HIV-positive people not receiving ART, viral load increased with decreasing CD4(+) cell count (500-749 vs. 750cells/l, adjusted mean difference, 0.40log(10)copies/ml, 95% CI 0.20-0.60, P<0.01). Conclusion: This study demonstrates how population-level data can help optimize HIV programs. Based on these results, new regional programs are prioritizing diagnosis and expanding ART eligibility, key steps to reach undetectable viral load.
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