@article{fdi:010066914,
  title = {{C}loser to 90-90-90. {T}he cascade of care after 10 years of {ART} scale-up in rural {M}alawi : a population study},
  author = {{M}aman, {D}. and {C}hilima, {B}. and {M}asiku, {C}. and {A}youba, {A}hidjo and {M}asson, {S}. and {S}zumilin, {E}. and {P}eeters, {M}artine and {F}ord, {N}. and {H}einzelmann, {A}. and {R}iche, {B}. and {E}tard, {J}ean-{F}ran{\c{c}}ois},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction: {T}he antiretroviral therapy ({ART}) programme supported by {M}edecins {S}ans {F}rontieres in the rural {M}alawian district of {C}hiradzulu was one of the first in sub-{S}aharan {A}frica to scale up {ART} delivery in 2002. {A}fter more than a decade of continuous involvement, we conducted a population survey to evaluate the cascade of care, including population viral load, in the district. {M}ethods: {A} cross-sectional household-based survey was conducted between {F}ebruary and {M}ay 2013. {U}sing a multistage cluster sampling method, we recruited all individuals aged 15 to 59 years living in 4125 randomly selected households. {E}ach consenting individual was interviewed and tested for {HIV} at home. {A}ll participants who tested positive had their {CD}4 count and viral load measured. {T}he {LA}g-{A}vidity assay was used to distinguish recent from long-term infections. {V}iral suppression was defined as a viral load below 1000 copies/m{L}. {R}esults: {O}f 8271 individuals eligible for the study, 7269 agreed to participate and were tested for {HIV} (94.1% inclusion for women and 80.3% for men). {O}verall {HIV} prevalence and incidence were 17.0% (95% {CI} 16.1 to 17.9) and 0.39 new cases per 100 person-years (95% {CI} 0.0 to 0.77), respectively. {C}overage at the other steps along the {HIV} care cascade was as follows: 76.7% (95% {CI} 74.4 to 79.1) had been previously diagnosed, 71.2% (95% {CI} 68.6 to 73.6) were under care and 65.8% (95% {CI} 62.8 to 68.2) were receiving {ART}. {F}inally, the proportion of participants who were {HIV} positive with a viral load <= 1000 copies/m{L} reached 61.8% (95% {CI} 59.0 to 64.5). {C}onclusions: {T}his study demonstrates that a high level of population viral suppression and low incidence can be achieved in high {HIV} prevalence and resource-limited settings.},
  keywords = {{HIV} ; incidence ; prevalence ; viral load ; {MALAWI}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {A}ids {S}ociety},
  volume = {19},
  numero = {},
  pages = {art. 20673 [8 p.]},
  ISSN = {1758-2652},
  year = {2016},
  DOI = {10.7448/ias.19.1.20673},
  URL = {https://www.documentation.ird.fr/hor/fdi:010066914},
}