Antiretroviral Drug Use in a Cross-Sectional Population Survey in Africa: NIMH Project Accept (HPTN 043).
Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence.



Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir).



ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors ± 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018).



This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.
*Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; †Department of Probability and Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic; ‡Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD; §Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; ‖Program in Global Health, University of California at Los Angeles, Los Angeles, CA; ¶Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; #Department of Global Health, University of Washington, Seattle, WA; **Muhimbili University of Health and Allied Sciences, Muhimbili University Teaching Hospital, Dar es Salaam, Tanzania; ††DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa; ‡‡Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa; §§South African Medical Research Council, Cape Town, South Africa; ‖‖Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC; and ¶¶Center for World Health, David Geffen School of Medicine and UCLA Health, Los Angeles, CA.
Jessica M
JM
Fogel
William
W
Clarke
Michal
M
Kulich
Estelle
E
Piwowar-Manning
Autumn
A
Breaud
Matthew T
MT
Olson
Mark A
MA
Marzinke
Oliver
O
Laeyendecker
Agnès
A
Fiamma
Deborah
D
Donnell
Jessie K K
JK
Mbwambo
Linda
L
Richter
Glenda
G
Gray
Michael
M
Sweat
Thomas J
TJ
Coates
Susan H
SH
Eshleman
Alfred H
AH
Chingono
D000293:Adolescent; D000328:Adult; D000349:Africa; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009315:National Institute of Mental Health (U.S.); D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
D044966:Anti-Retroviral Agents