20th International AIDS Conference - Melbourne, Australia


WEAC0101 - Oral Abstract

From efficacy to effectiveness: ART uptake and HIV seroincidence by ART status among HIV discordant couples in Zambia

Presented by Kristin Wall (United States).

K. Wall1,2, M. Inambao3, K. Simpungwe3, R. Parker2, J. Abdallah2, N. Ahmed3, W. Kilembe4, A. Tichacek2, E. Chomba5, J. Pulerwitz6, I. Thior7, S. Allen2

1Emory University, Department of Epidemiology, Atlanta, United States, 2Rwanda Zambia HIV Research Group, Emory University, Department of Pathology & Laboratory Medicine, Atlanta, United States, 3Rwanda Zambia HIV Research Group, Emory University, Department of Pathology & Laboratory Medicine, Ndola, Zambia, 4Rwanda Zambia HIV Research Group, Emory University, Department of Pathology & Laboratory Medicine, Lusaka, Zambia, 5Ministry of Community Development, Mother and Child Health, Lusaka, Zambia, 6Population Council, New York, United States, 7Program for Appropriate Technology in Health (PATH), Washington, DC, United States

Background: WHO and Zambian National Guidelines recommend antiretroviral treatment (ART) for HIV+ individuals in discordant relationships. Though the efficacy of “treatment as prevention” (TasP) has been explored, the effectiveness, including ART acceptability and adherence in discordant couples, has not been extensively evaluated. In environments of high HIV prevalence, prohibitive ART costs, limited ART access, and declining budgets, the question of TasP effectiveness is critical.
Methods: Couples'' Voluntary HIV Counseling and Testing (CVCT) has been provided by the Rwanda Zambia HIV Research Group in Zambian government clinics in Lusaka since 2007 and Southern Province since 2009. With Canadian International Development Agency (CIDA) funding, CVCT expanded to Copperbelt Province in August 2010. History of prior testing, pregnancy, and ART use are collected from CVCT clients, and ART referrals are provided to HIV+ partners. In 2011, quarterly follow-up was instituted. We evaluated ART uptake among discordant couples. We also calculated seroincidence by ART use among discordant couples in Copperbelt.
Results: In Lusaka, 5,560 discordant couples self-reported ART use/non-use at their initial CVCT visit. This data was available for 3,263 couples in Southern Province and 6,479 in Copperbelt. Among HIV+ partners previously tested, approximately 70% were not on ART at their first visit. In Lusaka and Southern Province, only 12% of discordant couples attended a CVCT follow-up visit compared to 20% in Copperbelt. Almost 30% of HIV+ partners had initiated ART at follow-up. In Copperbelt, 17 genetically linked seroconversions occurred in 382 couple-years (CY) (4.5/100CY;95%CI: 2.6-7.1). Seroincidence was 2.7/100CY (95%CI:1.1-5.7) for those on ART and 7.9/100CY (95%CI:3.8-14.5) for those not on ART.
Conclusions: ART uptake among HIV+ individuals in discordant relationships was low. The CIDA-funded CVCT expansion led to testing of more couples over a shorter period of time relative to other regions and a significantly higher follow-up rate that allowed for seroincidence estimates. ART effectiveness in our cohort is much lower than in randomized trials likely due to access and adherence issues. Given reduced HIV transmission rates in discordant couples after CVCT irrespective of ART, CVCT with follow-up testing for discordant couples, an effective and locally affordable prevention intervention, should be provided and promoted in government clinics.

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