Demographic and risk group heterogeneity across the UNAIDS 90-90-90 targets: a systematic review and meta-analysis protocol

Dylan Green; Brenda Kharono; Diana M Tordoff; Adam Akullian; Anna Bershteyn; Michelle Morrison; Geoff Garnett; Ann Duerr; Paul Drain

doi:10.1186/s13643-019-1024-6

Demographic and risk group heterogeneity across the UNAIDS 90-90-90 targets: a systematic review and meta-analysis protocol

Syst Rev. 2019 May 6;8(1):110. doi: 10.1186/s13643-019-1024-6.

Authors

Dylan Green^{1

2}, Brenda Kharono^{3

4}, Diana M Tordoff^{3

4}, Adam Akullian^{3

5}, Anna Bershteyn⁵, Michelle Morrison⁶, Geoff Garnett⁶, Ann Duerr^{3

4

7}, Paul Drain^{3

4

8}

Affiliations

¹ Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195, Washington, USA. greend7@uw.edu.
² Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington, 98195, USA. greend7@uw.edu.
³ Departments of Epidemiology and Global Health, University of Washington, 1959 NE Pacific St, Seattle, 98195, Washington, USA.
⁴ Strategic Analysis, Research & Training (START) Center, University of Washington, 1510 San Juan Rd NE, 3rd floor, Seattle, Washington, 98195, USA.
⁵ Institute for Disease Modeling, 3150 139th Ave SE, Building IV, Bellevue, 98005, Washington, USA.
⁶ Bill and Melinda Gates Foundation, 500 5th Ave N, Seattle, 98109, Washington, USA.
⁷ HIV Vaccine Trials Network, Vaccine and Infectious Disease and Public Health Science Divisions, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, 98109, Washington, USA.
⁸ Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, 98195, Washington, USA.

Abstract

Background: Despite policies for universal HIV testing and treatment (UTT) regardless of CD4 count, there are still 1.8 million new HIV infections and 1 million AIDS-related deaths annually. The UNAIDS 90-90-90 goals target suppression of HIV viral load in 73% of all HIV-infected people worldwide by 2030. However, achieving these targets may not lead to expected reductions in HIV incidence if the remaining 27% (persons with unsuppressed viral load) are the drivers of HIV transmission through high-risk behaviors. We aim to conduct a systematic review and meta-analysis to understand the demographics, mobility, geographic distribution, and risk profile of adults who are not virologically suppressed in sub-Saharan Africa in the era of UTT.

Methods: We will review the published and grey literature for study sources that contain data on demographic and behavioral strata of virologically suppressed and unsuppressed populations since 2014. We will search PubMed and Embase using four sets of search terms tailored to identify characteristics associated with virological suppression (or lack thereof) and each of the individual 90-90-90 goals. Record screening and data abstraction will be done independently and in duplicate. We will use random effects meta-regression analyses to estimate the distribution of demographic and risk features among groups not virologically suppressed and for each individual 90-90-90 goal.

Discussion: The results of our review will help elucidate factors associated with failure to achieve virological suppression in sub-Saharan Africa, as well as factors associated with failure to achieve each of the 90-90-90 goals. These data will help quantify the population-level effects of current HIV treatment interventions to improve strategies for maximizing virological suppression and ending the HIV epidemic.

Systematic review registration: PROSPERO CRD42018089505 .

Keywords: 90-90-90; Africa; Antiretroviral therapy; Care cascade; HIV; HIV diagnosis; Meta-analysis; Risk-factors; Systematic review; Viral suppression; Virological suppression.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa South of the Sahara
CD4 Lymphocyte Count
Demography*
Global Health
Goals*
HIV Infections* / diagnosis
HIV Infections* / drug therapy
HIV Infections* / transmission
Humans
Meta-Analysis as Topic
Risk Factors
Systematic Reviews as Topic
Viral Load* / drug effects