Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)

Menard L Chihana; Helena Huerga; Gilles Van Cutsem; Tom Ellman; Eric Goemaere; Stephen Wanjala; Charlie Masiku; Elisabeth Szumilin; Jean-Francois Etard; David Maman; Mary-Ann Davies

doi:10.1080/16549716.2019.1679472

Distribution of advanced HIV disease from three high HIV prevalence settings in Sub-Saharan Africa: a secondary analysis data from three population-based cross-sectional surveys in Eshowe (South Africa), Ndhiwa (Kenya) and Chiradzulu (Malawi)

Glob Health Action. 2019;12(1):1679472. doi: 10.1080/16549716.2019.1679472.

Authors

Menard L Chihana^{1

2}, Helena Huerga³, Gilles Van Cutsem^{2

4}, Tom Ellman⁴, Eric Goemaere⁴, Stephen Wanjala⁵, Charlie Masiku⁶, Elisabeth Szumilin⁷, Jean-Francois Etard⁸, David Maman^{2

5}, Mary-Ann Davies²

Affiliations

¹ Epicentre, Cape Town, South Africa.
² School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
³ Epicentre, Paris, France.
⁴ MSF Southern Africa Medical Unit (SAMU), Cape Town, South Africa.
⁵ MSF Nairobi, Nairobi, Kenya.
⁶ MSF Lilongwe, Lilongwe, Malawi.
⁷ MSF, Paris, France.
⁸ International Research Unit (UMI), IRD UMI 233, INSERM U1175, Montpellier University, TransVIHMI, Montpellier, France.

Abstract

Background: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality.Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa.Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September-November 2012), (Chiradzulu (Malawi): February-May 2013) and (Eshowe (South Africa): July-October 2013). Eligible individuals 15-59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/µl. We used logistic regression to identify patient characteristics associated with advanced HIV.Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8-10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4-9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8-14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2-17.5) than women 7.5% (95%CI 6.6-8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ≥6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7-2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3-2.1).Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention.

Keywords: ART; Africa; CD4; HIV; population-level.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anti-Retroviral Agents / therapeutic use
CD4 Lymphocyte Count
Cross-Sectional Studies
Female
HIV Infections / diagnosis*
HIV Infections / drug therapy
HIV Infections / epidemiology*
Humans
Kenya / epidemiology
Logistic Models
Malawi / epidemiology
Male
Middle Aged
Odds Ratio
Prevalence
Severity of Illness Index
Sex Factors
South Africa / epidemiology
Young Adult

Substances

Anti-Retroviral Agents

Grants and funding

Not applicable.