Geospatial and temporal mapping of detectable HIV-1 viral loads amid dolutegravir rollout in KwaZulu-Natal, South Africa.

Autor:	Gounder L; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa.; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Tomita A; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.; KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa., Lessells R; KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa., Moodley S; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.; South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa., Francois KL; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa.; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Khan A; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa.; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Pillay M; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa.; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Manyana SC; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa., Govender S; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa., Govender K; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Moodley P; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa.; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Parboosing R; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.; School of Pathology, University of Witwatersrand & National Health Laboratory Service, Johannesburg, South Africa., Msomi N; Department of Virology, Inkosi Albert Luthuli Academic Complex, National Health Laboratory Service, Durban, South Africa.; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa., Tanser F; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.; Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa.; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.; Centre for Epidemic Response and Innovation, School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa.; DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa., Naidoo K; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.; South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa., Chimukangara B; Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.; South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.; Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 May 28; Vol. 4 (5), pp. e0003224. Date of Electronic Publication: 2024 May 28 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0003224
Abstrakt:	South Africa rolled out dolutegravir (DTG) as first-line antiretroviral therapy (ART) in December 2019 to overcome high rates of pretreatment non-nucleoside reverse transcriptase inhibitor drug resistance. In the context of transition to DTG-based ART, this study spatiotemporally analysed detectable HIV viral loads (VLs) prior to- and following DTG rollout in public-sector healthcare facilities in KwaZulu-Natal (KZN) province, the epicentre of the HIV epidemic in South Africa. We retrospectively curated a HIV VL database using de-identified routine VL data obtained from the National Health Laboratory Service for the period January 2018 to June 2022. We analysed trends in HIV viraemia and mapped median log10 HIV VLs per facility on inverse distance weighted interpolation maps. We used Getis-Ord Gi* hotspot analysis to identify geospatial HIV hotspots. We obtained 7,639,978 HIV VL records from 736 healthcare facilities across KZN, of which 1,031,171 (13.5%) had detectable VLs (i.e., VLs ≥400 copies/millilitre (mL)). Of those with detectable VLs, we observed an overall decrease in HIV VLs between 2018 and 2022 (median 4.093 log10 copies/mL; 95% confidence interval (CI) 4.087-4.100 to median 3.563 log10 copies/mL; CI 3.553-3.572), p<0.01 (median test). The downward trend in proportion of HIV VLs ≥1000 copies/mL over time was accompanied by an inverse upward trend in the proportion of HIV VLs between 400 and 999 copies/mL. Moreover, specific coastal and northern districts of KZN had persistently higher VLs, with emergent hotspots demonstrating spatial clustering of high median log10 HIV VLs. The overall decrease in HIV VLs over time shows good progress towards achieving UNAIDS 95-95-95 targets in KZN, South Africa. The DTG-transition has been associated with a reduction in VLs, however, there is a need for pre-emptive monitoring of low-level viraemia. Furthermore, our findings highlight that specific districts will need intensified HIV care despite DTG rollout. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Gounder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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