Viral suppression in HIV–positive teens, young women in Africa far below UNAIDS target

The prevalence of viral load suppression was well below UNAIDS targets in adolescent girls and young women in seven African nations between 2015 and 2017, according to a report by the CDC.

“The [Population-based HIV Impact Assessment (PHIA)] surveys provide the first population-level estimates of viral load suppression for adolescent girls and young women in seven countries surveyed,” Kristin Brown, MPH, a health scientist and the CDC, and colleagues wrote in MMWR. “Although it is encouraging that among adolescent girls and young women who were aware that they were HIV positive, 86% reported that they were receiving ART and 82% of those achieved viral suppression, more remains to be done.

“Less than half (46.3%) of HIV-positive adolescent girls were aware of their HIV-positive status, which is well below the 90% UNAIDS target, and based on the reported current use of ART, coverage at the population level among adolescent girls and young women with diagnosed HIV infection ranged from 78% to 90%.”

Brown and colleagues noted that an estimated 1.5 million females aged 15 to 24 years were living with HIV in Eastern and Sothern Africa, and that in that population the prevalence of HIV infection was more than double that for males of the same age range (3.4% vs. 1.4%).

The authors calculated the national prevalence of HIV infections of females aged 15 to 24 years, the percentage aware of their status and the percentage who achieved viral suppression among those aware of their status. Data from PHIA surveys from the seven countries were used.

There were 32,273 females in the age range eligible for participation in the survey, with 93% participating in the interview and 94% of those interviewed participating in the survey’s biomarker portion.

Among the adolescent girls and young women, there was a combined prevalence of HIV infection of 3.6% (range, 2.1% to 13.9%). There were 85.5% of participants who were aware of their HIV-positive status reporting current ART use (range, 77.9%-89.7%). Regardless of awareness of HIV-positive status or reported current use of ART the overall prevalence of viral load suppression among the females was 45% (range, 33.6% to 55.5%).

“There has been notable progress toward overall HIV epidemic control in countries in this region,” the authors wrote. “… In contrast to these successes in the general adult population, the 45% prevalence for viral load suppression among adolescent girls and young women is well below the 73% target, suggesting the strategies have been more broadly successful in initiating and keeping adults with HIV on ART are less successful in this population. Even as significant progress has been made toward achieving the 90/90/90 targets in these countries, additional targeted strategies are needed to reach some groups, particularly adolescent girls and young women.” – Bruce Thiel

Reference: Brown K, et al. MMWR Morb Mortal Wkly Rep. Jan. 11, 2018.

Disclosure: Brown reports no relevant financial disclosures. Please see the full study for a listing of the other relevant financial disclosures.