Longitudinal trends in the prevalence of detectable HIV viremia: Population-based evidence from rural KwaZulu-Natal, South Africa

Abstract

Background

The prevalence of detectable viremia has previously been used to infer the potential for ongoing HIV transmission. To date, no study has evaluated the longitudinal change in the prevalence of detectable viremia within the HIV-positive community (PDV₊) and the entire population (PDV_P) using data from a sub-Saharan African setting.

Methods

In 2011, 2013, and 2014, we obtained 6,752 HIV-positive and 15,415 HIV-negative test results from a population-based surveillance system in the KwaZulu-Natal province of South Africa. We quantified the PDV₊ as the proportion of the 6,752 HIV-positive results with a viral load >1,550 copies/mL and the PDV_P as the proportion of the 6,752 HIV-positive and 15,415 HIV-negative results with a viral load >1,550 copies/mL.

Results

Between 2011 and 2014, the PDV₊ decreased by 16.5 percentage points (pp) for women (from 71.8% to 55.3%) and 10.6 pp for men (from 77.8% to 67.2%). However, a steady rise in the overall HIV prevalence, from 26.7% to 32.4%, offset the declines in the PDV₊ for both sexes. For woman, the PDV_P decreased by only 2.1 pp, from 21.3% to 19.2%; but for men, the PDV_P actually increased by 1.6 pp, from 14.6% to 16.2%, over the survey period.

Discussion

The PDV₊, which is currently being tracked under the UNAID 90-90-90 targets, may not be accurate indicator of the potential for ongoing HIV transmission. There is a critical need for countries to monitor and report the prevalence of detectable viremia among all adults (PDV_P), irrespective of HIV status.