ABSTRACT
Background: Achieving UNAIDS global 95 targets among people living with HIV (PLHIV) is key to HIV epidemic control. Eswatini, a country with one of the severest HIV epidemics, has implemented an aggressive national HIV response with comprehensive HIV prevention and treatment services. We assessed progress towards these targets in the high HIV disease burden setting of Eswatini. Method(s): We compared 95-95-95 indicators and HIV incidence from two sequential Population-based HIV Impact Assessment (PHIA) surveys conducted in Eswatini in 2016 and 2021. These PHIAs were similarly designed as nationally representative household surveys among individuals 15 years and older. Respondents completed interviews and provided blood samples for HIV rapid testing (Determine and Unigold), antiretrovirals (ARV) testing, and viral load (VL) measurement. The first 95 (diagnosed PLHIV) was assessed by self-report or detectable ARVs;second 95 (on treatment) by self-report or detectable ARVs among diagnosed PLHIV, and third 95 (VL suppression, VLS) as VL < 1,000 copies/mL among PLHIV on treatment. Annual HIV incidence was estimated from recent infections (classified by HIV-1 LAg avidity assay, VL and ARV detection) using the formula recommended by the World Health Organization Incidence Working Group. Survey weights accounting for sample selection probabilities and adjusted for nonresponse and noncoverage were applied. Result(s): The 11,199 adults in the 2021 PHIA were at 94-97-96, while the 10,934 adults in the 2016 PHIA were at 87-89-91, a statistically significant increase of 5-10% in all 95 indicators (see Table). Target achievement varied by sex, but all 95 indicators improved among men (92-96-97 in 2021 vs 80-90-91 in 2016) and women (95-98-96 in 2021 vs 91-88-91 in 2016). Overall annual HIV incidence declined by 45% from 1.13% in 2016 to 0.62% in 2021 (p = 0.055). Annual HIV incidence in 2021 was nearly seven times higher among women (1.11%) than among men (0.17%). Conclusion(s): These findings reflect substantial progress toward HIV epidemic control, a remarkable achievement in the context of health, social and economic disruptions and challenges associated with the COVID-19 era. The 2021 data highlight remaining gaps in knowledge of HIV status, particularly among men, and HIV incidence reduction, particularly among women.
ABSTRACT
Background: While nationwide SARS-CoV-2 testing in the United States shifted from facility- to home-based in 2021, less is known about testing behavior of older adults who live at home. We analyze characteristics of older adults who reported facility-based testing with those who tested only at home or at both locations. Method(s): Adults 70 years and older living at home with a landline in New York City were selected using random digit dialing and completed a COVID-19 survey from February 2022 - March 2022. We conducted descriptive statistics using survey weights and bi-variable and multivariable analyses. Result(s): Overall, 237 of a total of 294 (81%) participants had tested for SARS-CoV-2 in the prior year. Among those who tested, 81% had tested only at a facility, 4% only tested at home, and 15% tested at both locations (home and facility). White participants more often reported testing at both locations (27%) compared to Black (7%), Latinx (7%) or participants of another race (11%;p-value: 0.004). Those with college education or higher were less likely to rely solely on facilities for testing (75%) compared to those with less education (91%;p-value: 0.02) and 38% of those who reported currently working had tested both locations compared to only 12% of those who were not working (pvalue: 0.002). There were no differences in testing by age, sexual orientation, or self-reported mobility. A multivariable logistic regression model that compared those who only tested at a facility with those who tested at both locations or only at home found that when adjusting for working status, age group and education, compared to White participants, Black participants had a third (0.33) the odds of white participants of testing at home or at both locations (p-value: 0.026). Conclusion(s): In this sample of urban older adults, using a facility for SARS-CoV-2 testing was more frequently reported than testing at home, indicating the need to retain facility-based testing for this population. However, White participants, more educated participants and those who were working more frequently reported home-based testing compared to other groups suggesting that social constraints may limit access to home testing among the latter group of older adults.
ABSTRACT
This article briefly discusses how the understanding of Omicron variant may affect the response to the pandemic, highlighting that vaccines are the game changers. This new reality motivated by the emergence of the Omicron variant is relevant only for those who are fortunate enough to have access to effective COVID-19 vaccines and booster doses.
ABSTRACT
Background: The COVID-19 pandemic has impacted healthcare access due to travel restrictions, fear of exposure at health facilities (HF), changes in national policies and redirection of resources. We aimed to examine the impact that COVID-19 had on specific HIV activities including HIV testing, antiretroviral therapy (ART) initiation and viral load (VL) testing and suppression (VLS) at President's Emergency Plan for AIDS Relief (PEPFAR)-supported HF in 11 African countries. Methods: Retrospective routine data collected quarterly (Q) [Q1:October- December 2019;Q2:January-March 2020;Q3:April-June 2020;Q4:July- September 2020] from 1059 ICAP-supported HF in Angola (HF=17), Burundi (HF=88), Cameroon (HF=73), Cote d'Ivoire (HF=145), the Democratic Republic of Congo (HF=199), Eswatini (HF=42), Ethiopia (HF=31), Kenya (HF=1), Mozambique (HF=59), South Sudan (HF=20) and Zambia (HF=384) were analyzed to determine quarterly trends along the HIV testing and treatment cascade. Results: Overall, there was a 3.3% decrease in the number HIV tested from Q2 (572,845) to Q3 (553,780) (Figure 1). This change varied by country ranging from a 57% decrease in Kenya (5,460 to 2,364) to a 104% increase in Cameroon (45,940 to 93,735). The number testing HIV-positive in all countries declined by 5.0% from Q2 (22,662) to Q3 (21,553) with little change in yield (4.0% vs. 3.9%). In Q4 the number HIV tested increased by 10.6% (to 612,646) from Q3, and the number testing HIV+ increased by 9.0% (23,457) with little change in yield (3.8%). New ART initiations declined by 9.8% from Q2 to Q3 but increased again by 9.8% in Q4 (Q2:24,918;Q3:22,469;Q4:24,665). In every quarter, the number of patients currently on ART increased-Q1:419,028;Q2:435,852;Q3:454,208 and Q4:476,010. The number receiving a VL test also increased (Q1:255,290;Q2:276,001;Q3:297,876;Q4:312,869) with slight increases in the percentage with VLS (Q1:87.5%;Q2:88.6%;Q3:89.7%;Q4:90.1%). Conclusion: In this large study, with the of COVID-19 pandemic acceleration from Q2 to Q3, the number HIV tested decreased along with declines in number of HIV+ persons identified and new ART initiations. However, rebound was brisk as the pandemic progressed (Q4), demonstrating remarkable HIV program resilience. The number on ART, VL testing and VLS continued to increase throughout the period. This may have been, in part, due to recent expansions of non-HF-based differentiated service delivery models that include more diverse groups.