Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage
Author(s)
Type
Journal Article
Abstract
Introduction
To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which human immunodeficiency virus (HIV) viraemia is concentrating.
Methods
We analysed HIV testing and viral load data collected between 2013 and 2019 from the open, population-based Rakai Community Cohort Study in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, 1-year age bands, and residence in inland and fishing communities. All estimates were standardized to the underlying source population by using census data. We then assessed 95–95–95 targets in their ability to identify the populations in which viraemia is concentrated.
Results
Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%–5.3%) in 2013 to 1.9% (1.7%–2.2%) in 2019 in inland communities and from 19.1% (18.0%–20.4%) in 2013 to 4.7% (4.0%–5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95–95–95 targets. Instead, in both inland and fishing communities, women aged 25–29 years and men aged 30–34 years were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or having already achieved 95–95–95 targets.
Conclusion
The 95–95–95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.
To prioritize and tailor interventions for ending AIDS by 2030 in Africa, it is important to characterize the population groups in which human immunodeficiency virus (HIV) viraemia is concentrating.
Methods
We analysed HIV testing and viral load data collected between 2013 and 2019 from the open, population-based Rakai Community Cohort Study in Uganda, to estimate HIV seroprevalence and population viral suppression over time by gender, 1-year age bands, and residence in inland and fishing communities. All estimates were standardized to the underlying source population by using census data. We then assessed 95–95–95 targets in their ability to identify the populations in which viraemia is concentrated.
Results
Following the implementation of Universal Test and Treat, the proportion of individuals with viraemia decreased from 4.9% (4.6%–5.3%) in 2013 to 1.9% (1.7%–2.2%) in 2019 in inland communities and from 19.1% (18.0%–20.4%) in 2013 to 4.7% (4.0%–5.5%) in 2019 in fishing communities. Viraemia did not concentrate in the age and gender groups furthest from achieving 95–95–95 targets. Instead, in both inland and fishing communities, women aged 25–29 years and men aged 30–34 years were the 5-year age groups that contributed most to population-level viraemia in 2019, despite these groups being close to or having already achieved 95–95–95 targets.
Conclusion
The 95–95–95 targets provide a useful benchmark for monitoring progress towards HIV epidemic control, but do not contextualize underlying population structures and so may direct interventions towards groups that represent a marginal fraction of the population with viraemia.
Date Issued
2025-08-01
Date Acceptance
2025-06-27
Citation
International Journal of Epidemiology, 2025, 54 (4)
ISSN
0300-5771
Publisher
Oxford University Press
Start Page
dyaf126
Journal / Book Title
International Journal of Epidemiology
Volume
54
Issue
4
Copyright Statement
Copyright © 2025 Elsevier. This is the author’s accepted manuscript made available under a CC-BY licence in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy)
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40795077
PII: 8232691
Subjects
Universal Test and Treat
population-based study
prospective cohort
sub-Saharan Africa
viraemia
viral load suppression
Humans
HIV Infections
Male
Female
Adult
Viremia
Viral Load
Uganda
Young Adult
Middle Aged
Adolescent
Cohort Studies
HIV Seroprevalence
Epidemics
Child
Sex Factors
Age Factors
Anti-Retroviral Agents
Child, Preschool
Publication Status
Published
Coverage Spatial
England
Article Number
dyaf126
Date Publish Online
2025-08-12