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. 2017 Feb 1;74(2):158-165.
doi: 10.1097/QAI.0000000000001229.

Antiretroviral Drug Use in a Cross-Sectional Population Survey in Africa: NIMH Project Accept (HPTN 043)

Jessica M Fogel  1 , William Clarke, Michal Kulich, Estelle Piwowar-Manning, Autumn Breaud, Matthew T Olson, Mark A Marzinke, Oliver Laeyendecker, Agnès Fiamma, Deborah Donnell, Jessie K K Mbwambo, Linda Richter, Glenda Gray, Michael Sweat, Thomas J Coates, Susan H Eshleman, Alfred H Chingono
Affiliations

Antiretroviral Drug Use in a Cross-Sectional Population Survey in Africa: NIMH Project Accept (HPTN 043)

Jessica M Fogel et al. J Acquir Immune Defic Syndr. .

Erratum in

Abstract

Background: Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence.

Methods: Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir).

Results: ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors ± 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018).

Conclusions: This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.

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Conflict of interest statement

Conflict of Interests None of the authors has a conflict of interest or potential conflict of interest, with the following exception: William Clarke is a consultant to Thermo Fisher Scientific.

Figures

Figure 1
Figure 1. Detection of antiretroviral drugs in samples collected during the HPTN 043 post-intervention survey
Blood samples were collected from HIV-infected participants in HPTN 043 in a post-intervention household survey. Stored plasma samples were retrospectively tested for the presence of 20 antiretroviral (ARV) drugs. The graph shows the percentage of individuals at each of the four African study sites who had at least one ARV drug detected in their study sample. Data are presented for 6-month intervals during the survey.
Figure 2
Figure 2. Association of ARV drug use with HIV incidence
Stored plasma samples collected from HIV-infected participants during the post-intervention survey in HPTN 043 were tested for the presence of 20 antiretroviral (ARV) drugs. ARV drug use was defined as detection of at least one ARV drug. The graph shows the relationship between ARV drug use at each of the four African study sites and HIV incidence (determined in the HPTN 043 trial,). Site-specific regression lines are shown.
See this image and copyright information in PMC

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