@article{fdi:010084461,
  title = {{T}he {HIV} cascade of care among serodiscordant couples in four high {HIV} prevalence settings in sub-{S}aharan {A}frica},
  author = {{C}hihana, {M}.{L}. and {C}onan, {N}. and {E}llman, {T}. and {P}oulet, {E}. and {G}arone, {D}.{B}. and {O}rtuno, {R}. and {W}anjala, {S}. and {M}asiku, {C}. and {E}tard, {J}ean-{F}ran{\c{c}}ois and {D}avies, {M}.{A}. and {M}aman, {D}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground. {HIV}-serodiscordant couples are at high risk of {HIV} transmission. {I}n sub-{S}aharan {A}frica, {HIV}-serodiscordant couples contribute average 30% of all new infections in the region. {O}bjectives. {T}o quantify the prevalence of {HIV}-serodiscordant couples and evaluate steps of the {HIV} cascade of care among people living with {HIV} in serodiscordant relationships in four high-prevalence settings in sub-{S}aharan {A}frica. {M}ethods. {F}our {HIV} prevalence surveys were conducted: in {N}dhiwa ({K}enya) in 2012, in {C}hiradzulu ({M}alawi) in 2013, and in {G}utu ({Z}imbabwe) and {N}sanje ({M}alawi) in 2016. {E}ligible individuals aged 15 - 59 years were asked to participate in voluntary rapid {HIV} testing. {V}iral load and {CD}4 counts were measured on those who tested {HIV}-positive. {A} couple was defined as a man and a woman who reported being married or cohabiting and were living together in the same household. {R}esults. {A}mong 4 385 couples, the prevalence of {HIV} serodiscordancy was 10.9% (95% confidence interval ({CI}) 10.2 - 11.5) overall, ranging from 6.7% (95% {CI} 5.6 - 7.9) in {N}sanje to 15.8% (95% {CI} 14.5 - 17.3) in {N}dhiwa. {M}en were the {HIV}-positive partner in 62.7% of the serodiscordant couples in {N}dhiwa, in 60.4% in {G}utu, in 48.8% in {C}hiradzulu and in 50.9% in {N}sanje. {S}tatus awareness among {HIV}-positive partners in serodiscordant couples ranged from 45.4% in {N}dhiwa to 70.7% in {G}utu. {V}iral load suppression ({VLS}) ranged from 33.9% in {N}dhiwa to 68.5% in {N}sanje. {VLS} was similar by sex in three settings, {N}dhiwa (37.8% (men) v. 27.8% (women); p=0.16), {N}sanje (60.7% v. 76.9%; p=0.21) and {G}utu (48.2% v. 55.6%; p=0.63), and dissimilar by sex in {C}hiradzulu (44.4% v. 62.7%; p=0.03). {C}onclusions. {L}ow {HIV} status awareness and poor {VLS} among {HIV}-positive partners are major gaps in preventing transmission among serodiscordant couples. {I}ntensifying programmes that target couples to test for {HIV} and timely antiretroviral therapy initiation could increase {VLS} and reduce {HIV} transmission.},
  keywords = {{KENYA} ; {MALAWI} ; {ZIMBABWE}},
  booktitle = {},
  journal = {{S}outh {A}frican {M}edical {J}ournal},
  volume = {111},
  numero = {8},
  pages = {768--776},
  ISSN = {0256-9574},
  year = {2021},
  DOI = {10.7196/{SAMJ}.2021.v111i8.15489},
  URL = {https://www.documentation.ird.fr/hor/fdi:010084461},
}