Abstract
IntroductionHIV care and treatment in cross‐border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, particularly for mobile and migrant populations. Here, we estimate the proportion of people with HIV found in these cross‐border areas in each stage of the HIV care and treatment cascade, including the proportion who knows their status, the proportion on treatment and the proportion virally suppressed.MethodsParticipants (n = 11,410) working or socializing in public places in selected East Africa cross border areas were recruited between June 2016 and February 2017 using the Priorities for Local AIDS Control Efforts method and administered a behavioural survey and rapid HIV test. This approach was designed to recruit a stratified random sample of people found in public spaces or venues in each cross border area. For participants testing positive for HIV, viral load was measured from dried blood spots. The proportion in each step of the cascade was estimated using inverse probability weights to account for the sampling design and informative HIV test refusals. Estimates are reported separately for residents of the cross border areas and non‐residents found in those areas.ResultsOverall, 43% of participants with HIV found in cross‐border areas knew their status, 87% of those participants were on antiretroviral therapy (ART), and 80% of participants on ART were virally suppressed. About 20% of people with HIV found in cross border areas were sampled outside their subdistrict or subcounty of residence. While both resident and non‐resident individuals who knew their status were likely to be on ART (85% and 96% respectively), people on ART recruited outside their area of residence were less likely to be suppressed (64% suppressed; 95% CI: 43, 81) compared to residents (84% suppressed; 95% CI: 75, 93).ConclusionsPeople living in or travelling through cross‐border areas may face barriers in learning their HIV status. Moreover, while non‐residents were more likely to be on treatment than residents, they were less likely to be suppressed, suggesting gaps in continuity of care for people in East Africa travelling outside their area of residence despite timely initiation of treatment.
Highlights
HIV care and treatment in cross-border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, for mobile and migrant populations
The UNAIDS 90-90-90 targets are designed to minimize the proportion of the population with an unsuppressed viral load by ensuring that 90% of people living with HIV know their status, 90% of those who know their status are on antiretroviral therapy (ART), and 90% of those on ART are virally suppressed [9]
People with HIV working or socializing in East Africa crossborder areas were unlikely to know their HIV status, those who knew their HIV status were likely to be on treatment and suppressed: while only 43% knew their HIV-positive status, 84% of people who knew their status were on ART and 80% of those on ART had a suppressed viral load
Summary
HIV care and treatment in cross-border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, for mobile and migrant populations. Methods: Participants (n = 11,410) working or socializing in public places in selected East Africa cross border areas were recruited between June 2016 and February 2017 using the Priorities for Local AIDS Control Efforts method and administered a behavioural survey and rapid HIV test. This approach was designed to recruit a stratified random sample of people found in public spaces or venues in each cross border area. The SEARCH trial, along with HIV prevention trials in other regions (e.g. the PopART trial in Zambia and South Africa [11]) have identified several promising strategies to increase access to HIV testing [12,13], retention in care [14], ART initiation [13] and viral suppression through universal testing and treatment
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