Abstract
BackgroundDespite policies for universal HIV testing and treatment (UTT) regardless of CD4 count, there are still 1.8 million new HIV infections and 1 million AIDS-related deaths annually. The UNAIDS 90-90-90 goals target suppression of HIV viral load in 73% of all HIV-infected people worldwide by 2030. However, achieving these targets may not lead to expected reductions in HIV incidence if the remaining 27% (persons with unsuppressed viral load) are the drivers of HIV transmission through high-risk behaviors. We aim to conduct a systematic review and meta-analysis to understand the demographics, mobility, geographic distribution, and risk profile of adults who are not virologically suppressed in sub-Saharan Africa in the era of UTT.MethodsWe will review the published and grey literature for study sources that contain data on demographic and behavioral strata of virologically suppressed and unsuppressed populations since 2014. We will search PubMed and Embase using four sets of search terms tailored to identify characteristics associated with virological suppression (or lack thereof) and each of the individual 90-90-90 goals. Record screening and data abstraction will be done independently and in duplicate. We will use random effects meta-regression analyses to estimate the distribution of demographic and risk features among groups not virologically suppressed and for each individual 90-90-90 goal.DiscussionThe results of our review will help elucidate factors associated with failure to achieve virological suppression in sub-Saharan Africa, as well as factors associated with failure to achieve each of the 90-90-90 goals. These data will help quantify the population-level effects of current HIV treatment interventions to improve strategies for maximizing virological suppression and ending the HIV epidemic.Systematic review registrationPROSPERO CRD42018089505.
Highlights
Despite policies for universal Human immunodeficiency virus (HIV) testing and treatment (UTT) regardless of Cluster of differentiation 4 (CD4) count, there are still 1.8 million new HIV infections and 1 million Acquired immune deficiency syndrome (AIDS)-related deaths annually
The results of our review will help elucidate factors associated with failure to achieve virological suppression in sub-Saharan Africa, as well as factors associated with failure to achieve each of the 90-90-90 goals
The HIV care cascade and these goals aim for 90% of people living with HIV (PLHIV) to know their status, of whom 90% link to and initiate antiretroviral treatment (ART) and of whom 90% achieve virological suppression by 2020 [2]
Summary
This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines [9]. Records will be excluded from consideration at title, abstract, and full text review stages if they satisfy any of the following exclusion criteria: study only among HIV-negative persons, study on persons outside of sub-Saharan Africa setting, study on children aged under 15, study of an inappropriate design, study data collected exclusively prior to January 2014, or study does not report on at least one of the 90-90-90 outcomes (Table 2). At least two reviewers will assess the risk of selection bias, reporting bias, and attrition bias for each study included for data abstraction by using an adapted Cochrane Risk of Bias Tool including items for non-randomized studies [27]. Definitions used to define strata and levels of the HIV care cascade, and study characteristics including geography and study design will be summarized in the narrative.
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