Keywords
1. UNAIDS 90-90-90 targets
2. HIV viral suppression Sub-Saharan Africa
3. HIV risk behavior meta-analysis
4. Antiretroviral therapy adherence
5. HIV epidemic systematic review
Despite robust policies advocating for universal HIV testing and treatment (UTT) irrespective of CD4 count, the world still faces a formidable task in trying to curb the HIV epidemic. With ambitions to suppress the HIV viral load in 73% of all people living with HIV across the globe by 2030, UNAIDS has set the 90-90-90 goals as a beacon of hope in the fight against this relentless virus. However, recent findings suggest that without addressing the demographic and risk group heterogeneity, specifically in regions like sub-Saharan Africa, the envisioned reduction in HIV incidence may not materialize as a significant risk remains predominantly with the unsuppressed 27% population – a group identified as potential drivers of the epidemic due to high-risk behaviors.
A deep dive into these concerns is precisely what the upcoming systematic review and meta-analysis, under the aegis of the University of Washington’s esteemed departments of Epidemiology and Global Health and a host of significant contributors, aim to accomplish. Detailed in the protocol published on the 6th of May 2019 in “Systematic Reviews,” the study proposes to scrutinize the demographics, mobility, geographic distribution, and risk profiles of adults who are not virologically suppressed in the era of UTT.
The outlined protocol, registered with PROSPERO (CRD42018089505) and detailed with a DOI: 10.1186/s13643-019-1024-6, highlights a meticulous methodology to map out the demographic and behavioral strata of both virologically suppressed and unsuppressed populations since 2014. The research initiative, led by Green Dylan D. among others, will sift through published and gray literature, employing a strategic use of PubMed and Embase databases to extract relevant data using carefully formatted search terms tailored to the objectives at hand.
The study’s findings will be instrumental in exposing the significant variations within the ‘last mile’ of HIV care: the gaps in viral suppression. The focus on the sub-Saharan African context is critical as the region bears a disproportionate burden of the disease; the insights gained here are expected to have far-reaching implications concerning the global HIV response.
One of the primary concerns highlighted in previous reports, such as those by Huerga et al., 2017 (DOI: 10.1038/s41598-017-16382-6), and Akullian et al., 2017 (DOI: 10.1097/QAD.0000000000001638), has been the association of higher risk sexual behavior with lack of awareness regarding HIV-positivity and unsuppressed viral loads. By engaging in comprehensive data extraction and employing random effects meta-regression analyses, the proposed study could unveil intricate patterns and distribution of these risk features.
Moreover, the implications of understanding the multi-layered demographic and risk-based peculiarities cannot be understated. Sub-Saharan Africa’s UTT programs might benefit greatly from this nuanced understanding, with potential alterations in strategies accelerating the pursuit of the 90-90-90 targets. The findings could very well prompt a reevaluation of current intervention strategies, leading to more targeted initiatives, considering the variations in treatment adherence, geographic challenges, and high-risk behaviors.
This study would also add considerable weight to the growing body of evidence demanding a more stratified approach to HIV care and prevention. For example, Tanser et al., 2013 (DOI: 10.1126/science.1228160), demonstrated the positive effects of ART coverage on decreasing HIV acquisition risks at the community level. In light of these studies and the comprehensive systematic review underway, a more customized approach might be necessary to encompass the multifaceted nature of the HIV epidemic in sub-Saharan Africa.
In terms of impact, this meta-analysis is poised to influence not only healthcare policy and resource allocation but also guide future research endeavors requiring regional specificity. As the high-stakes 2030 deadline for the UNAIDS 90-90-90 targets looms ever closer, the research led by Green Dylan D. and colleagues is expected to play a pivotal role in directing the efforts of organizations and governments alike in sub-Saharan Africa, ensuring that no demographic or risk group falls through the cracks in the quest to suppress HIV prevalence.
From a broader perspective, this study resonates with global health goals and serves as a reminder of the shifting paradigms within the realm of public health research. As health threats like HIV evolve, so must our strategies to combat them, adapting and refining our approach in light of fresh evidence and insights.
In summary, the upcoming systematic review and meta-analysis by Green Dylan D. and his team underscore the critical need for a granular examination of the demographic intricacies and risk behaviors associated with HIV suppression across sub-Saharan Africa. The revelations from their work are expected to have profound implications, serving as a catalyst to refine intervention strategies, ensuring they are as effective and inclusive as possible, and moving the needle closer to defeating the HIV epidemic once and for all.
References
1. UNAIDS. “90-90-90 an ambitious treatment target to help end the AIDS epidemic.” (2016).
2. Huerga H, et al. “Higher risk sexual behaviour is associated with unawareness of HIV-positivity and lack of viral suppression – implications for treatment as prevention.” Sci Rep. (2017);7(1):16117. doi: 10.1038/s41598-017-16382-6.
3. Akullian A, et al. “The missing 27%: implications for closing the gap in the UNAIDS 90-90-90 targets.” AIDS. (2017);31(17):2427–2429. doi: 10.1097/QAD.0000000000001638.
4. Tanser F, et al. “High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa.” Science (80- ). (2013);339(6122):966–971. doi: 10.1126/science.1228160.
5. Green Dylan D, et al. “Systematic reviews: Demographic and risk group heterogeneity across the UNAIDS 90-90-90 targets: a systematic review and meta-analysis protocol.” Syst Rev. (2019);8(1):110. doi: 10.1186/s13643-019-1024-6.