Research

Recency of HIV infection, antiretroviral therapy use and viral loads among symptomatic sexually transmitted infection service attendees in South Africa

T Kufa, F Radebe, E Cutler, M Goosen, L Wiesner, D Greyling, V Maseko, R Kularatne, A Puren

Abstract


Background. Better integration of HIV and sexually transmitted infection (STI) prevention and treatment services is needed to accelerate progress towards the goal of zero new HIV infections.

Objectives. To describe HIV positivity, antiretroviral therapy (ART) use, viral suppression and recency of HIV infection among symptomatic STI service attendees at two primary care clinics in South Africa.

Methods. In a cross-sectional study, male and female STI service attendees presenting with symptoms consistent with STI syndromes were enrolled following informed consent. An interviewer-administered questionnaire was completed and appropriate genital and blood specimens were collected for STI testing and HIV biomarker measurements including recency of infection and antiretroviral (ARV) drug levels. Descriptive statistics were used to describe enrolled attendees, and to determine the proportion of attendees who were HIV-positive, recently infected, taking ART and virally suppressed. HIV-positive attendees with detectable ARVs were considered to be on ART, while those with viral loads (VLs) ≤200 copies/mL were considered virally suppressed.

Results. Of 451 symptomatic attendees whose data were analysed, 93 (20.6%) were HIV-positive, with 15/93 (16.1%) being recently infected. Recent infection was independently associated with genital ulcer disease at presentation, especially ulcers with no detectable STI pathogens. Among the 78 (83.9%) with long-term infection, only 30 (38.5%) were on ART, with 23/30 (76.7%) virally suppressed.

Conclusions. In a population at risk of HIV transmission, there was a high burden of recent infection and unsuppressed VLs. Incorporating pre-exposure prophylaxis, ART initiation and adherence support into STI services will be necessary for progress towards eliminating HIV transmission


Authors' affiliations

T Kufa, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

F Radebe, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa

E Cutler, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa

M Goosen, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa

L Wiesner, Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

D Greyling, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa

V Maseko, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa

R Kularatne, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Clinical Microbiology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

A Puren, Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa; Division of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

HIV; Transmission; Sexually transmitted infections; Recent infection; Viral loads

Cite this article

South African Medical Journal 2022;112(2):96-101.

Article History

Date submitted: 2022-02-01
Date published: 2022-02-01

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