Title

Progress toward HIV epidemic control: Results from the Namibia Population-Based HIV Impact Assessment (PHIA)

Presenter

Bernard Haufiku

Authors

N. Hamunime¹, A. Wolkon², M. Grasso³, D.B. Williams², A.D. Maher³, A. Low⁴, B. Pitt⁴, J.B. Palmier², K. Banda³, T. Shuumbwa¹, A. Mengistu¹, S. Agolory², G. Rutherford³, A.-M. Nitschke¹, N. Mutenda¹, L.A. Miller², S. Sawadogo², O. Mwazi⁵, H. Simtaa⁵, B. Makumbi⁶, N. Pentinaiken⁶, S. Israel⁶, B. Parekh², D. Prybylski², K. Sachathep⁴, J. Justman⁷, B. Haufiku¹

Institutions

¹Namibia Ministry of Health and Social Services, Windhoek, Namibia, ²U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Atlanta, United States, ³University of California in San Francisco, Institute for Global Health Sciences, San Francisco, United States, ⁴ICAP at Columbia University, New York, United States, ⁵Namibia Statistics Agency, Windhoek, Namibia, ⁶Namibia Institute of Pathology, Windhoek, Namibia, ⁷Columbia University, Epidemiology and Medicine, Hastings-on-Hudson, United States

Background: In 2015, Namibia implemented an Acceleration Plan rapidly scaling up HIV testing and treatment services with the goal of reaching the UNAIDS 90-90-90 targets by 2020. In 2017, Namibia conducted the Namibia Population-based HIV Impact Assessment (NAMPHIA) to estimate HIV viral load suppression (VLS) and progress toward the 90-90-90 targets.
Methods: NAMPHIA was a cross-sectional household-based survey conducted between June and December, 2017; analyses were weighted to account for complex survey design. Eligible adults aged 15-64 years who consented were interviewed and offered HIV rapid testing according to national guidelines. All HIV-seropositive (HIV+) samples were tested for viral load at a central laboratory. The 90-90-90 targets were defined as: (1^st 90) the proportion of people living with HIV (PLHIV) who reported knowing their HIV+ status; (2^nd 90) the proportion of PLHIV who knew their status and reported being on antiretroviral therapy (ART); and (3^rd 90) the proportion of PLHIV who reported being on ART who had measured VLS (HIV RNA < 1,000 copies/ml).
Results: Of 16,939 participants, 2,446 tested HIV+ (Overall/Total HIV prevalence=12.6%; female=15.7%, male= 9.3%). Among all PLHIV, irrespective of knowledge of HIV+ status and reported ART status, 77.4% had VLS (female VLS=81.7%, male VLS=69.6%) [Table]. Among PLHIV, 78.8% reported knowing that they were HIV+ (female=83.1%, male=71.1%). Among PLHIV who reported knowing their HIV+ status, 95.3% reported being on ART, (female ART=96.0%, male ART=93.8%). Among PLHIV who reported ART use, 91.5% had VLS (female VLS=92.2%, male VLS=89.9%). (Table)
Conclusions: Namibia is the first country in Africa to have reached and surpassed at a national level the UNAIDS 2020 goal of having at least 73% of all people living with HIV be virally suppressed. NAMPHIA data also show that once diagnosed, a high proportion (≥ 90%) of both male and female PLHIV initiated ART and achieved VLS. While this is a remarkable accomplishment, 21.2% of PLHIV are unaware of their HIV+ status, including almost 30% of men. Strategies to improve HIV testing, particularly for men, are urgently needed to ensure Namibia''s continued progress towards HIV epidemic control.

Table 1
[Table 1]

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