Cape Times

Innovative way to target HIV infections

- Staff Writer

A KWAZULU-NATAL research institute has developed a new method to predict where the highest rate of new HIV infections will likely occur, allowing for targeted treatment and interventi­ons.

Using cutting-edge data analytical methods, Africa Health Research Institute (AHRI) scientists show that population viral load measures, which have previously been used to try to predict the intensity of new HIV infections in a particular area, do not accurately predict HIV incidence in a rural South African setting.

The researcher­s were led by AHRI faculty scientist Professor Frank Tanser, who is also the UKZN Professor of Epidemiolo­gy and Honorary Professor at University College London.

“As countries gear up to meet the UNAids 90-90-90 HIV treatment targets, accurately measuring progress and providing evidence of the impact of widespread treatment on life expectancy as well as the rate of new HIV infections is critical,” he said.

One of the accepted ways of doing this is using this measuremen­t. HIV viral load level – or the amount of virus present in a person’s semen or blood – is the single most important biological factor when it comes to HIV transmissi­on.

This means the higher a person’s viral load, the more infectious they are.

Based on this, calculatin­g an average viral load for every HIV infected person living in a community over a given period could predict the potential for transmissi­on and thus the future rate of new HIV infections.

In this AHRI study in partnershi­p with the University of KwaZulu-Natal and University College London, 8 732 research participan­ts living in the programme area between 2011 and 2015 were involved.

The researcher­s found that many of the methods currently used do not accurately predict HIV incidence in a particular community. Once they adjusted the metrics to take into account spatial variations in viral load patterns as well as proportion of HIV infections within a community, the measures became highly predictive.

The authors have also cautioned against using routine health facility-based viral load data only to predict the transmissi­on potential of similar rural settings, as they found this data doesn’t give an accurate prediction of rate of new HIV infections.

They also found high viral loads were 40% more prevalent in men compared with women. Tanser said this reflects observatio­ns throughout Africa showing that men are less likely to be tested for HIV and successful­ly link to HIV care, as well as being less likely to successful­ly adhere to treatment.

“In this era of decreasing HIV funding, it’s critical that we make the best use of the resources available.

“One way we can do this is to target areas of high transmissi­on.

“Using these indices we can now identify vulnerable communitie­s where future rates of new HIV infections will be highest – which will be useful in guiding prevention interventi­on strategies.

“One of the reasons that the rate of new infections is so high among women is because their male partners have high viral loads as a consequenc­e of them not accessing HIV care and treatment.

“At AHRI we are looking at innovative solutions including financial incentives for men to test and treat, as well as gender sensitive mobile and technology options,” said Tanser.

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