Abstract
BackgroundPersons living with HIV (PLWH) who are members of sero-discordant and sero-concordant relationships may experience psychological stressors or motivators that affect HIV care. We assessed the association between sero-discordance status, antiretroviral therapy (ART) uptake, and viral suppression in the African Cohort Study (AFRICOS).MethodsAFRICOS enrolls PLWH and HIV-uninfected individuals at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, we determined ART use through self-report. Viral suppression was defined as HIV RNA < 1000 copies/mL. We analyzed PLWH who were index participants within two types of sexual dyads: sero-discordant or sero-concordant. Binomial regression models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ART use and viral suppression at study enrollment.ResultsFrom January 2013 through March 2018, 223 index participants from sero-discordant dyads and 61 from sero-concordant dyads were enrolled. The majority of the indexes were aged 25–34 years (50.2%), female (53.4%), and married (96.5%). Sero-discordant indexes were more likely to disclose their status to partners compared with sero-concordant indexes (96.4% vs. 82.0%, p < 0.001). After adjustment, sero-discordant index participants were more likely to be on ART (aPR 2.8 [95% CI 1.1–6.8]), but no more likely to be virally suppressed. Results may be driven by unique psycho-social factors and global implementation of treatment as prevention.ConclusionsPLWH in sero-discordant sexual partnerships demonstrated improved uptake of ART compared with those in sero-concordant partnerships. Interventions are needed to increase care engagement by individuals in sero-concordant relationships to improve HIV outcomes.
Highlights
Persons living with HIV (PLWH) who are members of sero-discordant and sero-concordant relationships may experience psychological stressors or motivators that affect HIV care
As related to partnership dynamics and key HIV indicators, a greater proportion of sero-discordant index partners had partners who were aware of their HIV status (96.4% vs. 82.0% p < 0.0001), had a longer duration on antiretroviral therapy (ART) (7.8 years [4.8–10.4] vs. 2.8 [1.7–5.7], p < 0.0001), and had more advanced World Health Organization (WHO) clinical staging (I: 22.4% vs. 45.9%, II: 60.5% vs. 44.3%, III and IV: 13.1% vs. 9.8%, p = 0.0010) compared with sero-concordant index partners
The median viral load was 17 copies/mL (IQR: 1–3350) and a larger proportion of sero-discordant index partners were virally suppressed at all thresholds, 77.1% vs 44.3% with a viral load < 1000 copies/mL, 72.7% vs 41.0% with a viral load < 200 copies/mL, and 69.5% vs 34.4% with a viral load < 50 copies/mL compared with sero-concordant index partners
Summary
Persons living with HIV (PLWH) who are members of sero-discordant and sero-concordant relationships may experience psychological stressors or motivators that affect HIV care. We assessed the association between sero-discordance status, antiretroviral therapy (ART) uptake, and viral suppression in the African Cohort Study (AFRICOS). With widespread uptake of antiretroviral therapy (ART), persons living with HIV (PLWH) are living longer and more ordinary lives, which includes forming romantic relationships [1, 2]. A sero-discordant couple is a romantic or sexual relationship where one person within the couple is living with HIV and the other person is not. Transmission of HIV within sero-discordant married or cohabitating couples comprises a significant proportion of new infections in Sub-Saharan Africa and transmission within this key population is an important and preventable driver of the HIV epidemic [5, 6]. ART uptake, adherence, and subsequent viral suppression may be influenced by factors such as healthcare access, disease severity, stigma, discrimination, social support, and HIV status disclosure [9,10,11]
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