Findings from the 2016 Zambia Populationbased HIV Impact
Findings from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA): HIV prevalence, incidence and progress towards the 90 -90 -90 goals Danielle T. Barradas, Ph. D. U. S. Centers for Disease Control and Prevention – Lusaka, Zambia 25 July 2017
Disclosures and Disclaimers • I have no financial interests or any other conflicts of interest to disclose. • The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the U. S. Centers for Disease Control and Prevention or other participating institutions. • These findings are preliminary and may be subject to change.
Zambia Sociodemographic Overview • 2015 midyear population: 15. 4 million • Average household size: 5. 1 members • 68% households have access to improved sources of drinking water; 40% have access to improved sanitation • Life expectancy at birth: 53 y • Total fertility: 5. 3 births per woman • Under 5 mortality: 75 per 1000 births Source: 2015 Selected Socio‐economic Indicators Report
HIV/AIDS in Zambia • HIV/AIDS is the #1 health threat in Zambia and the leading cause of morbidity and mortality among adults (15 -49 y) • In 2014, 13 out of 100 adults were living with HIV in Zambia 13 people living with HIV 87 people without HIV • The lifetime risk of dying from HIV in Zambia is over 60%. Source: Zambia DHS, 2013‐ 14
TARGETS FOR ENDING THE AIDS EPIDEMIC BY 2030 of those with HIV know their status of those diagnosed are on ART of those on ART are virally suppressed
What is ZAMPHIA? • ZAMbia Population-based HIV Impact Assessment • A household-based national survey led by the Ministry of Health • Collection of behavioral and biomarker data with HIV testing with return of results and counseling • In collaboration with Central Statistical Office, Tropical Diseases Research Centre, University Teaching Hospital, University of Zambia, ICAP at Columbia University, and U. S. Centers for Disease Control and Prevention
ZAMPHIA Objectives To estimate the following in a household-based, nationally representative sample of adults age 15 -59: 1. HIV incidence at national level 2. Sub-national (provincial) prevalence of HIV viral load suppression (VLS) • Suppressed viral load = <1000 copies/m. L, suggests successful treatment and lower chance of transmission 3. Measure progress toward meeting UNAIDS 90 -90 -90 targets
Methods • 12, 310 eligible households in 511 enumeration areas • Behavioral and clinical information collected via adult and adolescent individual-level questionnaires • Demographic information collected via household questionnaire • Blood samples for HIV testing collected per national guidelines.
Methods • Confirmation of HIV-seropositive results using the Geenius supplemental assay • For this analysis, antiretroviral treatment is based on self-report. • Viral load and limiting antigen (LAg) avidity EIA testing were performed at a central lab on all HIV-seropositive samples. VLS was defined as HIV RNA <1000 copies/ml • Incidence was determined using results of LAg avidity and viral load testing • Statistical analyses completed using SAS v 9. 4 survey procedures
Scope of Presentation • Adult (15 -59 y) and pediatric (0 -14 y) HIV prevalence estimates • Adult HIV incidence estimates • Progress toward meeting the UNAIDS 90 -90 -90 targets among adults
ZAMPHIA Response Rates 89% 89% Household Response Rate 90% 81% 88% 77%* Interview Response Rate Adult Female 70% 69% target overall adult response – 68% actual 71% 63% 61% Blood Draw Overvall Response Overall Response Rate rate Response Adult Male Children <15 *Adolescents 10 -14
HIV Prevalence by Age and Sex: ZAMPHIA, 2016 35 HIV Prevalence (%) 30 Overall adult HIV prevalence: 12. 0% 25 20 Female 15 Male 10 5 0 0– 4 5– 9 10– 14 15– 19 20– 24 25– 29 30– 34 35– 39 40– 44 45– 49 50– 54 55– 59 Age (years)
HIV Prevlaence (%) Pediatric HIV Prevalence by Age and Sex: ZAMPHIA, 2016 3 2. 5 Overall pediatric HIV prevalence: 0. 9% Female 2 Male 1. 5 1 0. 5 0 0. 68 0. 94 1. 33 2. 20 1. 05 0. 72 0– 4 5– 9 10– 14 Age (years)
HIV Incidence by Sex and Age: ZAMPHIA, 2016 15– 59 years 15– 49 years Female % [95% CI] 1. 02% [0. 66, 1. 37] Male % [95% CI] 0. 32% [0. 10, 0. 54] Total % [95% CI] 0. 67% [0. 45, 0. 88] 1. 10% [0. 71, 1. 48] 0. 31% [0. 09, 0. 54] 0. 70% [0. 47, 0. 93] UNAIDS (2015) Total (15– 49 y): 0. 85 [0. 73, 0. 99]
VLS Prevalence among PLHIV (%) Viral Load Suppression among PLHIV by Sex and Age: ZAMPHIA, 2016* 80 70 Overall adult VLS: 59. 1% 60 50 Female 40 Male 30 20 10 0 38. 2 30. 0 0– 14 33. 6 36. 7 15– 24 56. 2 36. 7 25– 34 Age (years) 70. 0 60. 0 35– 44 73. 0 73. 3 45– 59 * Denominator is all PLHIV with viral load results.
Status of 90‐ 90 Targets: ZAMPHIA, 2016 100% Aware 84. 4 68. 3 On treatment 90. 1 Virally suppressed 86. 2 87. 7 85. 0 66. 0 62. 2 % Female Male Total 89. 3
Conclusions • Zambia is making progress toward the UNAIDS’ 90 -90 -90 targets • Declining national HIV incidence; however, incidence among women remains unacceptably high • Further exploration of gaps in testing, ART, and viral load suppression is needed • Preliminary findings point toward the need to increase HIV testing, treatment, retention and adherence for both young men and young women. • Examples of policy and programmatic implications: • Self-testing, expanded hours, more (male) healthcare workers • Minimizing delays in ART initiation by maximizing the number of ART sites • Full implementation of Test and Start, Pr. EP
Acknowledgements • ZAMPHIA participants • GRZ Ministry of Health (MOH): Crispin Moyo, Wezi Kaonga • Central Statistical Office (CSO): Nchimunya Nkombo • Tropical Diseases Research Centre (TDRC): Webster Kasongo • ICAP: Karampreet Sachathep, David Hoos, Kumbutso Dzekedzeke • CDC: Sundeep Gupta, Dan B. Williams, Bharat Parekh, Hetal Patel, Stanley Kamocha, Clement B. Ndongmo, Kathy Hageman, Margaret A. Riggs • ZAMPHIA study team
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