@article{fdi:010093794,
  title = {{P}opulation-level viremia predicts {HIV} incidence at the community level across the {U}niversal {T}esting and {T}reatment {T}rials in eastern and southern {A}frica},
  author = {{L}armarange, {J}oseph and {B}achanas, {P}. and {S}kalland, {T}. and {B}alzer, {L}.{B}. and {I}wuji, {C}. and {F}loyd, {S}. and {M}ills, {L}.{A}. and {P}illay, {D}. and {H}avlir, {D}. and {K}amya, {M}.{R}. and {A}yles, {H}. and {W}irth, {K}. and {D}abis, {F}. and {H}ayes, {R}. and {P}etersen, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{U}niversal {HIV} testing and treatment ({UTT}) strategies aim to optimize population-level benefits of antiretroviral treatment. {B}etween 2012 and 2018, four large community randomized trials were conducted in eastern and southern {A}frica. {W}hile their results were broadly consistent showing decreased population-level viremia reduces {HIV} incidence, it remains unclear how much {HIV} incidence can be reduced by increasing suppression among people living with {HIV} ({PLHIV}). {W}e conducted a pooled analysis across the four {UTT} trials. {L}everaging data from 105 communities in five countries, we evaluated the linear relationship between i) population-level viremia (prevalence of non-suppression-defined as plasma {HIV} {RNA} >500 or >400 copies/m{L}-among all adults, irrespective of {HIV} status) and {HIV} incidence; and ii) prevalence of non-suppression among {PLHIV} and {HIV} incidence, using parametric g-computation. {HIV} prevalence, measured in 257 929 persons, varied from 2 to 41% across the communities; prevalence of non-suppression among {PLHIV}, measured in 31 377 persons, from 3 to 70%; population-level viremia, derived from {HIV} prevalence and non-suppression, from < 1% to 25%; and {HIV} incidence, measured over 345 844 person-years ({PY}), from 0.03/100{PY} to 3.46/100{PY}. {D}ecreases in population-level viremia were strongly associated with decreased {HIV} incidence in all trials (between 0.45/100{PY} and 1.88/100{PY} decline in {HIV} incidence per 10 percentage points decline in viremia). {D}ecreases in non-suppression among {PLHIV} were also associated with decreased {HIV} incidence in all trials (between 0.06/100{PY} and 0.17/100{PY} decline in {HIV} incidence per 10 percentage points decline in non-suppression). {O}ur results support both the utility of population-level viremia as a predictor of incidence, and thus a tool for targeting prevention interventions, and the ability of {UTT} approaches to reduce {HIV} incidence by increasing viral suppression. {I}mplementation of universal {HIV} testing approaches, coupled with interventions to leverage linkage to treatment, adapted to local contexts, can reduce {HIV} acquisition at population level.},
  keywords = {{AFRIQUE} {DE} {L}'{EST} ; {AFRIQUE} {DE} {L}'{OUEST}},
  booktitle = {},
  journal = {{PL}o{S} {G}lobal {P}ublic {H}ealth},
  volume = {3},
  numero = {7},
  pages = {e0002157 [18 ]},
  ISSN = {2767-3375},
  year = {2023},
  DOI = {10.1371/journal.pgph.0002157},
  URL = {https://www.documentation.ird.fr/hor/fdi:010093794},
}