News – PHIA

LePHIA Data Link Climate Shock to HIV Infection Rates

January 29, 2019

There is a direct link between climate change and public health in Lesotho, according to findings from the Lesotho Population-Based HIV Impact Assessment (LePHIA). Data show that women and adolescent girls exposed to severe drought conditions in rural Lesotho were more likely to engage in high-risk behaviors, including sex work, and were more likely to drop out of school.

“This is the first paper to link climate shock to an HIV epidemic since antiretroviral drugs became more widely available in sub-Saharan Africa,” said Dr. Jessica Justman, senior technical director of ICAP at Columbia University and principal investigator of the PHIA Project. “We should view this as another kind of warning that climate change will affect us in unexpected and unwelcome ways.”

Read full news coverage on the Africa Times and Thomson Reuters Foundation websites.

View the findings published in PLOS Medicine.

Press Release: Final Results of National Survey Show Lesotho’s Remarkable Progress toward HIV Epidemic Control

January 17, 2019

PRESS RELEASE

January 16, 2019, Maseru – Today, the Government of Lesotho, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University (ICAP) announced the final results of the Lesotho Population-based HIV Impact Assessment (LePHIA) survey. These extensive new data builds off of preliminary data announced in November 2017, which showed the remarkable strides Lesotho is making toward controlling its HIV epidemic.

The results announced today include extensive data on prevalence, incidence and uptake of HIV services for adults, adolescents and children as well as updates to previously released figures. The updated figures are based on new laboratory data showing the number of people already tested and aware of their HIV status was higher than initially reported in 2017 (81% today vs 77% in 2017) and the annual HIV incidence (or new infections in a year) is slightly lower (1.1% today vs 1.5% in 2017).

“The LePHIA Final Report released today provides a breadth and depth of data that will greatly inform our approach to controlling Lesotho’s HIV epidemic,” said Hon. Nkaku Kabi, Minister of Health, Government of Lesotho. “The Government of Lesotho is committed to continuing the HIV care and treatment programs that are working and using new data to target gaps in services where we can better meet the needs of all our citizens.”

LePHIA was conducted from November 2016 to May 2017 and included 16,000 people ages 0-59 years across 10,000 randomly selected households. It is the first national survey to provide comprehensive information on important HIV/AIDS indicators at national and regional levels and measure progress toward the globally recognized UNAIDS 90-90-90 targets to be achieved by 2020, which include:

81% of adults who tested HIV positive in LePHIA who already knew their HIV status
92% of those who reported knowing their HIV-positive status who were taking antiretroviral therapy (ART)
Among those who reported current use of ART, 88% achieved viral load suppression – a marker of the effectiveness of ART
Among children, progress toward 90-90-90 show an estimated 81% of children living with HIV previously diagnosed and 98% of those on ART; however, only 74% had suppressed viral loads

“LePHIA data show Lesotho has made great strides toward achieving the UNAIDS targets and improving care for people living with HIV,” said Koen Frederix, Technical Director, ICAP at Columbia University. “Going forward, the data will enable us in our critical task of identifying and linking to care those infected with HIV but unaware of their status.”

In addition to achieving the UNAIDS targets, LePHIA data also show gaps where Lesotho can focus its efforts:

Reduce the number of people living with HIV: Approximately 306,000 people in the country between the ages of 0-59 years, or one out of four, are living with HIV
Increase the number of men tested for HIV: Men were less likely than women to report ever having been tested for HIV or to be aware of their prior HIV status
Target at-risk age groups: The rate of new infections was highest in females aged 15-24 years and in males it was highest among ages 35-49 years
Increase condom use: More than one in three married and/or cohabitating adults who engaged in extra-marital partnerships reported not using condoms
Increase access to voluntary male medical circumcision: Only 36.0% of men aged 15-59 years reported having undergone the procedure, an intervention shown to reduce the risk of HIV acquisition

LePHIA data also identified a gap in effectively delivering HIV services to older adolescents and young adults (15-24 years of age):

72% lacked comprehensive knowledge about HIV transmission and prevention, with one in four not knowing that monogamy with an uninfected partner may reduce risk of transmission
40% of those who tested HIV positive had not been previously diagnosed, and if treated only 77% achieved VLS.

With the addition of the LePHIA results, eleven countries have released results from PHIA Project surveys: Cameroon, Cote d’Ivoire, Eswatini, Ethiopia, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe. Data from further assessments in the coming years can be used to assess the progress countries have made since conducting their initial PHIA survey.

The PHIA Project is funded by the U.S. government through PEPFAR and conducted by the Ministries of Health, CDC, ICAP, and other governmental and non-governmental partners. With PEPFAR support, three additional countries – Haiti, Kenya, and Rwanda – will release PHIA data during 2019 and help chart further progress toward epidemic control by 2030.

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The U.S. President’s Emergency Plan for AIDS Relief

PEPFAR is the United States government’s response to the global HIV/AIDS epidemic, which represents the largest commitment by any nation to address a single disease in history. Through the compassion and generosity of the American people, PEPFAR has saved and improved millions of lives, accelerating progress toward controlling and ultimately ending the AIDS epidemic as a public health threat. For more information, please visit www.pepfar.gov, and connect with PEPFAR on Twitter, Facebook, and Instagram.

The U.S. Centers for Disease Control and Prevention

CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. HIV and tuberculosis (TB) are the world’s two most deadly infectious diseases, and CDC’s Division of Global HIV & TB works with partners to tackle these two epidemics and produce the greatest global health impact. More information can be found at http://www.cdc.gov/globalhivtb.

ICAP at Columbia University

ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

Press Release: Ministry of Health Launches National Survey to Measure the Reach and Impact of Rwanda’s HIV Programs

October 10, 2018

Press Release

Ministry of Health Launches National Survey to Measure the Reach and Impact of Rwanda’s HIV Programs

Rwanda Population-based HIV Impact Assessment (RPHIA) will survey 10,800 households across Rwanda.

Kigali, October 10, 2018

The Ministry of Health announced today the launch of the Rwanda Population-based HIV Impact Assessment (RPHIA). The national household-based survey will measure the reach and impact of Rwanda’s HIV prevention, care, and treatment services across the country. RPHIA is led by the Ministry of Health through the Rwanda Biomedical Centre and the Ministry of Economic Planning and Finance through the National Institute of Statistics of Rwanda in coordination with ICAP at Columbia University and the U.S. Centers for Disease Control and Prevention and support from the U.S. President’s Emergency Plan for AIDS Relief.

“Data collected from RPHIA will provide critical insights on the successes and challenges Rwanda faces in confronting the HIV epidemic. RPHIA participants will benefit from free and confidential HIV testing, counseling, and treatment referrals.”

RPHIA will begin collecting household data on October 12^th, 2018 in the Northern Province. The survey is anticipated to last through February 2019. Over the course of five months, trained survey personnel will visit approximately 10,800 randomly selected households and collect demographic, clinical, and behavioral information from consenting participants. Staff will also perform HIV and hepatitis B and C testing.

Results from HIV and hepatitis B virus tests will be returned to participants on the same day, and RPHIA will provide viral load testing for those who test HIV positive. Viral load suppression is a count of how much HIV virus is in the blood and can show if treatment is being used effectively. Participants who test positive for HIV and those selected for hepatitis B and C testing will be referred to health facilities of their choice for further follow up: to receive further counseling and HIV treatment, to receive the vaccine or treatment for hepatitis B, and to receive hepatitis C test results.

The Ministry of Health has led a systematic and sustained response to the HIV epidemic, which includes education on preventing HIV infection as well as universal access to effective HIV medications. Rwanda has intensified HIV testing and treatment strategies and prioritized evidence-based interventions with the goal of achieving epidemic control by 2020.

RPHIA aims to estimate new HIV infections (incidence), number of people living with HIV (prevalence), and viral load suppression among adults and adolescent children. Data collection, laboratory services, and data management will be provided by the Rwanda Biomedical Center in collaboration of the National Institute of Statistics of Rwanda and Westat, Inc. RPHIA includes technical assistance at the national level to strengthen data collection systems, enhance laboratory infrastructure, and strengthen local human resource capacity.

RPHIA will help health authorities and policymakers better understand the impact of HIV on everyone in the population, not only people living with HIV but also their family, friends, and the community at large. The success of the survey and the accuracy of the findings depend on the voluntary participation of all selected households and individuals. The Ministry of Health encourages local leaders, religious leaders, and the press to encourage people, congregations, and followers to consider participating in RPHIA if selected; and to portray a positive and accurate picture of the RPHIA survey to the public.

“RPHIA survey personnel have been extensively trained and are ready to implement a successful survey. It is the mission of all researchers to treat participants with respect, keep their personal information confidential, and ensure they have a positive experience with this important endeavor.”

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ICAP at Columbia University
ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

Press Release: New Data Show Dramatic Progress in Namibia Toward HIV Epidemic Control and Substantial Gaps in Cote d’Ivoire and Cameroon

July 25, 2018

Press Release

Amsterdam, July 25, 2018

The Government of the Republic of Namibia, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. Centers for Disease Control and Prevention (CDC), and ICAP at Columbia University (ICAP) released new data today at the 2018 International AIDS Conference demonstrating that the HIV epidemic is coming under control in Namibia.

Results from the Namibia Population-based HIV Impact Assessment (NAMPHIA) show that 77 percent of all HIV-positive adults in Namibia have achieved viral load suppression, a widely used measure of effective HIV treatment in a population, surpassing the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 73 percent by 2020. Compared with the UNAIDS 2012 estimates, Namibia has reduced its adult HIV incidence rate by 50 percent in the past five years. ‎

Namibia has made this tremendous progress by either reaching or exceeding the UNAIDS 90-90-90 targets among women and, nationally, by attaining 86-96-91 among adults. Namibia accomplished this through the strategic expansion of HIV prevention and treatment services, with a focus on viral load suppression at the individual and community level, and the swift implementation of forward-leading HIV policies.

NAMPHIA results also suggest that women ages 15-24 still have a far higher HIV incidence rate (0.99 percent) than same-aged young men (0.03 percent) in the country. This highlights the continued need for expanded primary HIV prevention in young women, including through the PEPFAR-led DREAMS Partnership, and ensuring all men 25-35 are virally suppressed, such as through the new MenStar Coalition.

“These exciting new data demonstrate that a community-centered approach results in high community viral suppression, which decreases the rates of new HIV infections. Several African countries are now on track to reach HIV epidemic control by 2020, accelerated progress that was only possible because of partner country political leadership and their rapid adoption of policies focusing primary prevention and treatment resources for maximum impact,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “Together, we are making the impossible possible, moving farther and faster toward ending AIDS as a public health threat by 2030.”

“The results of this survey demonstrate the importance of providing innovative, data-driven prevention, care and treatment to those affected by HIV,” said CDC Director Robert Redfield, M.D. “CDC continues to support Namibia’s efforts to control its HIV epidemic – and we remain committed to global efforts to change the course of the HIV pandemic and help save lives.”

The PHIAs evidence important advances being made under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). Among the ten countries (Cameroon, Cote d’Ivoire, Eswatini, Lesotho, Malawi, Namibia, Tanzania, Uganda, Zambia, and Zimbabwe) that have released PHIA results, Namibia has achieved the highest level of viral load suppression among all HIV-positive adults. Other countries surveyed show varying levels of progress toward reaching the viral suppression target of 73 percent, highlighting key areas for improvement, particularly the need to increase the coverage of HIV testing among adult men, adolescent girls, and young women.

“The impressive findings from the NAMPHIA survey demonstrate the Government of Namibia’s successful commitment to confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, ICAP global director. “The survey findings also provide a blueprint to guide HIV policies and programs in-country moving forward.”

New data from PHIAs in Cameroon and Cote d’Ivoire released earlier this week highlight substantial gaps in western Africa toward reaching epidemic control despite significant investments, pointing to the depth and breadth of key policy barriers to HIV service uptake that need to be addressed.

Overall, the PHIAs reveal key gaps in HIV prevention and treatment programming for women ages 15-24 and men ages 25-34 that require urgent attention and action. In all countries surveyed, lower percentages of these groups reported knowing their HIV status, current use of HIV treatment, and had viral suppression than older adults. PEPFAR is aggressively addressing these challenges, including through its innovative public-private partnerships.

The PHIAs are funded by the U.S. government, through PEPFAR, and conducted by the CDC, ICAP, and local governmental and non-governmental partners. With PEPFAR support, four additional countries – Ethiopia, Haiti, Kenya, and Rwanda – will release PHIA data on a rolling basis through 2019, providing an ability to chart and validate further progress toward reaching epidemic control by 2020.

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The U.S. President’s Emergency Plan for AIDS Relief
PEPFAR is the United States government’s response to the global HIV/AIDS epidemic, which represents the largest commitment by any nation to address a single disease in history. Through the compassion and generosity of the American people, PEPFAR has saved and improved millions of lives, accelerating progress toward controlling and ultimately ending the AIDS epidemic as a public health threat. For more information, please visit www.pepfar.gov, and connect with PEPFAR on Twitter, Facebook, and Instagram.

The U.S. Centers for Disease Control and Prevention
CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. HIV and tuberculosis (TB) are the world’s two most deadly infectious diseases, and CDC’s Division of Global HIV & TB works with partners to tackle these two epidemics and produce the greatest global health impact. More information can be found at http://www.cdc.gov/globalhivtb.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

NEJM Perspective: HIV Population Surveys – Bringing Precision to the Global Response

May 16, 2018

In a Perspective published in this week’s New England Journal of Medicine, Jessica Justman, Owen Mugurungi, and Wafaa El-Sadr show how Population-based HIV Impact Assessment (PHIA) data provide a robust picture of country-level HIV epidemics, including the gaps in the response, and help guide future actions with precision.

The article explains how PHIA surveys provide direct estimates of critically important measures, such as HIV incidence, population-level viral load suppression (defined as HIV RNA <1000 copies per milliliter), and other essential biomarkers countries and donors need to measure progress. Survey findings have revealed exceptional successes, such as a remarkably high prevalence of viral load suppression among adults living with HIV in three contiguous southern African countries (Malawi, Zambia, and Zimbabwe).

See two new maps: HIV Prevalence and Prevalence of Viral Load Suppression in the NEJM article for a new revealing look at the data (Data in the article, from First Reports and preliminary Summary Sheets, are publically available at phia.icap.columbia.edu).

The article also details the value of repeated surveys, which can reveal trends over time, as demonstrated by comparing results from the Swaziland HIV Incidence Measurement Survey 2 (SHIMS2, 2017) with SHIMS (2011). SHIMS2 data showed a dramatic reduction in HIV incidence (44%) and doubling of population viral load suppression (from 35% to 71% among HIV-positive people aged 18 to 49 years).

The article concludes with an overview of the efforts required to plan and implement population surveys, and a call for more accurate and current population-level data in order to measure progress and guide future policy, programs, and funding decisions with precision. Read the article here.

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Jessica Justman is the Senior Technical Director and PHIA Project Principal Investigator at ICAP at Columbia University; Owen Mugurungi is the Aids and TB Unit director in the Ministry of Health and Child Care, Zimbabwe; Wafaa El-Sadr is the Global Director of ICAP at Columbia University.

From New England Journal of Medicine, Jessica Justman, Owen Mugurungi, Wafaa El-Sadr, HIV Population Surveys – Bringing Precision to the Global Response, 378;20, 1859 Copyright © (2018) Massachusetts Medical Society. Reprinted with permission.

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About the Population-based HIV Impact Assessment Project

The PHIA Project was launched in 2014 to address the need for detailed population HIV measures. Initial findings are already available from seven countries in sub-Saharan Africa (Zimbabwe, Malawi, Zambia, Swaziland, Lesotho, Tanzania, and Uganda), where approximately 200,000 individuals from more than 85,000 households have been surveyed. PHIA surveys are funded by PEPFAR and conducted by ICAP at Columbia University in partnership with ministries of health and the US Centers for Disease Control and Prevention.

PHIA Project at CROI 2018

March 19, 2018

See below for PHIA Project presentations at the annual Conference on Retroviruses and Opportunistic Infections (CROI) held in Boston, Massachusetts from March 4-7, 2018.

Sunday, March 4, 2018

Clinical Trial Design and Analysis Workshop

Measuring Population-Level Impact of Interventions

Jessica Justman, PHIA Project principal investigator and senior technical director at ICAP

Tuesday, March 6, 2018

Oral Presentation

High HIV Burden among Children in Lesotho: Findings from a Population-Based Survey

Kyaw Thin, Ministry of Health, Lesotho

Poster Presentation

High HIV Burden among Children in Lesotho: Findings from a Population-Based Survey

Abstract

Progress Toward 90-90-90: 2016 Lesotho Population-based HIV Impact Assessment Results

PHIA Project Marks World AIDS Day 2017: Data Available from Seven Countries

December 1, 2017

On World AIDS Day 2017, the PHIA Project at ICAP at Columbia University, conducted in collaboration with the Centers for Disease Control and Prevention (CDC), announced the release of new data from five survey countries, including preliminary results from Lesotho and Tanzania. With this release, data are now available for seven countries where the population-based HIV impact assessments (PHIAs) were conducted. The release also marks one year since the PHIA Project announced preliminary results from the first three survey countries— Malawi, Zambia, and Zimbabwe—that showed exceptional progress against the HIV epidemic.

PHIA surveys are conducted in collaboration with ministries of health. As part of these surveys, household-based HIV counseling and testing is offered to all household members from selected households by trained survey staff, with return of results. The surveys also ask questions about access to preventive care and treatment services for adults and children. The results measure national and regional progress toward UNAIDS’ 90-90-90 goals and guide policy and funding priorities. Data from the PHIA Project are prepared and disseminated in stages in order to allow the release of preliminary data as soon as possible.

Additionally, today, the PHIA Project posted new First Reports for Malawi, Zambia, and Zimbabwe that present in-depth results on the state of national HIV epidemics by socio-demographics, clinical characteristics, and regions. These 70-page reports also describe design, methods, and response rates and include data on topics such as HIV incidence, prevalence, immune status, achievement of the 90-90-90 targets, prevention of mother-to-child transmission (PMTCT), and sexual behavior.

“The First Reports released today further inform our understanding of the progress made in confronting the HIV epidemic in these three countries,” said Wafaa El-Sadr, M.D., M.P.H., M.P.A., global director of ICAP. “These findings will be crucial in guiding policymakers, researchers, and health officials as they consider the way forward.”

The PHIA Project also released new Summary Sheets detailing preliminary results from two more countries, Lesotho and Tanzania, and updated the Swaziland (SHIMS2) Summary Sheet.

In Lesotho, results show that HIV viral load suppression among all HIV-positive adults —a key marker of the body successfully controlling the virus—has reached over 67 percent among 15- to 59-year olds. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the UNAIDS 90-90-90 targets and expanding HIV prevention. Full achievement of the 90-90-90 targets implies achieving a viral load suppression of 73 percent among all people living with HIV.

In Tanzania, HIV viral load suppression among all HIV-positive adults has reached 52%, and researchers noted Tanzania’s progress in reaching people diagnosed with HIV with antiretroviral treatment, care, and support. Data from the survey further indicate Tanzania’s HIV epidemic is stabilizing.

“The collaboration with ministries of health has been fundamental to the success of the PHIA surveys,” said Dr. Jessica Justman, PHIA Project principal investigator and senior technical director at ICAP. “The PHIA findings are eagerly anticipated by the countries as they examine their HIV response to date and their future plans to meet the needs of their citizens.”

ICAP also announced the first publication for the PHIA Project in a supplement issue of the Journal of the International AIDS Society (JIAS). The article describes how the vast majority of viral load results from the first three PHIA surveys were returned to each HIV-positive participant’s preferred health facility within the eight-week target, a significant achievement possible through contributions from partners including ministries of health, CDC, and Westat.

As of December 2017, the PHIA Project has announced preliminary results from seven countries, including Swaziland and Uganda earlier this year. In July, the PHIA Project announced Swaziland’s impressive progress in confronting its HIV epidemic — including nearly halving the rate of new HIV infections — at the International Aids Society 2017 Conference in Paris, France, and spotlighted the stabilization of Uganda’s epidemic during an event hosted by UNAIDS at the UN General Assembly in September 2017.

In the coming months, ongoing surveys in Cameroon, Cote d’Ivoire, Ethiopia, and Namibia will be completed, and surveys will commence in Haiti, Kenya, and Rwanda. The PHIA Project will post additional data in the form of Summary Sheets, Final Reports, and public-access datasets as they become available.

About the Population-based HIV Impact Assessment (PHIA) Project

The PHIA Project, led by ICAP at Columbia University in partnership with the US Centers for Disease Control and Prevention (CDC), and funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) measures the reach and impact of HIV programs in PEPFAR-supported countries through national surveys.

New PHIA Data Announced as World Leaders Gather in New York to Mark Progress toward Ending AIDS

October 17, 2017

With world leaders gathered in New York for the UN General Assembly, ICAP at Columbia University—in partnership with PEPFAR and CDC— announced new data on the state of HIV epidemics in Lesotho and Uganda. The data, derived from Population-based HIVImpact Assessment surveys, show remarkable progress in Lesotho and a stabilization of Uganda’s previously expanding epidemic.

In Lesotho, where ICAP conducted LePHIA from November 2016 to May 2017, results show HIV viral load suppression—a key marker of the body successfully controlling the virus—has reached over 67 percent among all HIV-positive adults ages 15-59. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the UNAIDS 90-90-90 targets and expanding HIV prevention. Full achievement of 90-90-90 is equal to viral load suppression among 73 percent of all people living with HIV.

In a press conference to announce the results, Deputy Prime Minister Monyane Moleleki confirmed the Lesotho government’s commitment to build on the achievements made and to keep addressing gaps shown in the survey data.

With the announcement of the LePHIA results, five African countries are now approaching control of their HIV epidemics: Lesotho, Malawi, Swaziland, Zambia, and Zimbabwe. In addition, Uganda’s epidemic has likely stabilized due to increases in coverage of voluntary medical male circumcision for HIV prevention, as well as expansion of HIV treatment, including for pregnant women living with HIV.

ICAP’s global director, Dr. Wafaa El-Sadr concurred that the results are cause for optimism, but also note that there is much work still to be done. “These findings show marked progress against HIV in Lesotho and Uganda, but also highlight the need for focused attention as we move forward,” she said. “It is evident that young people, particularly young men under 35 years of age, are reluctant to get tested for HIV, which hinders efforts to stem the spread of this infection. Reaching them is critically important to achieving the ultimate goal of ending this epidemic.”

To mark the progress countries have made toward the 90-90-90 targets and rally momentum around ending AIDS, Ugandan President Yoweri Museveni co-hosted a high-level event with UNAIDS in New York on Thursday, September 21. The event featured heads of state from Guinea, Malawi, Seychelles, Swaziland, Uganda, and Zambia, as well as Ambassador Birx and other distinguished guests.

The immense showing of world leaders spotlighted the energy and resources governments and the international community are focusing on HIV/AIDS. UNAIDS Executive Director Michel Sidibé noted, “Leadership, partnership, and innovation will transform the epidemic.” President Museveni added, “I am confident that working together with you all, we shall attain an AIDS-free Africa. It is possible to end AIDS in our generation!”

Header image: UNAIDS

Press Release: Five African countries approach control of their HIV epidemics as U.S. government launches bold strategy to accelerate progress

September 19, 2017

Press Release

Latest survey results show Lesotho’s significant success with HIV viral load suppression and stabilization of Uganda’s previously expanding epidemic.

Washington, D.C./New York, September 19, 2017— Data released today from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) show that the HIV epidemic is coming under control in Lesotho. These results add to prior PEPFAR-supported Population-based HIV Impact Assessments (PHIAs) announced in the last nine months for Malawi, Swaziland, Zambia, and Zimbabwe.

Together, these data demonstrate impressive progress toward controlling the HIV epidemics in the five countries. The latest data also indicate that the previously expanding epidemic in Uganda has now stabilized. None of these achievements would be possible without the political will and leadership to focus resources for maximum impact in each of these countries.

According to the new Lesotho PHIA results, HIV viral load suppression – a key marker of the body successfully controlling the virus – has reached over 67 percent among all HIV-positive adults ages 15-59. This finding suggests that Lesotho is on track to achieve epidemic control by 2020, through reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets and expanding HIV prevention. Uganda’s epidemic has likely stabilized due to increases in coverage of voluntary medical male circumcision for HIV prevention and expansion of HIV treatment, including for HIV-positive pregnant women.

Building on this progress, U.S. Secretary of State Rex Tillerson today released the new PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). The Strategy reaffirms the U.S. government’s leadership and commitment, through PEPFAR, to support HIV/AIDS efforts in more than 50 countries, ensuring access to services by all populations, including the most vulnerable and at-risk groups.

The Strategy outlines plans to accelerate implementation in a subset of 13 high-burden countries that have the potential to achieve epidemic control by 2020, working in collaboration with host governments, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, and other partners. Through this international effort, we expect not only to control the epidemic, but also to reduce the future costs required to sustain the HIV/AIDS response.

“With five African countries approaching control of their HIV epidemics, we have the extraordinary opportunity to change the very course of the HIV pandemic over the next three years,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “We are deeply grateful for Secretary Tillerson’s bold leadership and clear vision in launching this landmark Strategy. PEPFAR is poised to deliver on it, showing that what once seemed impossible is now possible.”

Data from these six countries were gathered through national surveys (PHIAs), which are funded by the U.S. government through PEPFAR, and conducted by the U.S. Centers for Disease Control and Prevention (CDC), ICAP at Columbia University’s Mailman School of Public Health, and local governmental and non-governmental partners. With PEPFAR support, seven additional countries will complete PHIAs on a rolling basis through 2017-2019, providing an ability to chart and validate their respective progress toward reaching epidemic control by 2020.

“CDC is so pleased to contribute to the global HIV response, working with ministries of health and other partners on science-based solutions that are transforming some of the world’s most severe HIV epidemics,” said CDC Director Brenda Fitzgerald, M.D. “National surveys are critical to show the impact of efforts and to chart the path to fully achieve HIV epidemic control.”

While the PHIA results demonstrate tremendous progress, they also reveal key gaps in HIV prevention and treatment programming for younger men and women that require urgent attention and action. In all six surveys, young women and men under age 35 were less likely to know their HIV status, be on HIV treatment, or be virally suppressed than older adults. These gaps are all areas in which PEPFAR will continue to invest and innovate under its new strategy. In particular, PEPFAR will continue to advance efforts to reduce HIV incidence among adolescent girls and young women through the DREAMS Partnership and reach and link more young men to HIV services.

“The findings from the six countries provide a report card on the global and local efforts in confronting the HIV epidemics while at the same time help in shaping a blueprint for their future course as they continue their quest to stem this epidemic,” said Wafaa El-Sadr, M.D., M.P.H., M.P.A., global director of ICAP. “The gaps identified in reaching young women and men are relevant to many other countries around the world, and addressing them is critically important to achieving the ultimate goal of ending this epidemic.”

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About the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
PEPFAR is the U.S. government’s response to the global HIV/AIDS epidemic, which represents the largest commitment by any nation to address a single disease in history. Through the compassion and generosity of the American people, PEPFAR has saved and improved millions of lives, accelerating progress toward controlling and ultimately ending the AIDS epidemic as a public health threat. For more information, please visit www.pepfar.gov, and follow PEPFAR on Twitter, Facebook, and Instagram.

About the U.S. Centers for Disease Control and Prevention (CDC)
CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. HIV and tuberculosis (TB) are the world’s two most deadly infectious diseases, and CDC’s Division of Global HIV & TB works with partners to tackle these two epidemics and produce the greatest global health impact. More information can be found at www.CDC.gov/globalhivtb.

About ICAP at Columbia University
ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats, and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs, and over 1.3 million have received antiretroviral therapy through such support.

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

Major Progress in Confronting HIV in Swaziland Announced at IAS 2017

August 1, 2017

The Population-based HIV Impact Assessment (PHIA) Project announced major findings from the Swaziland survey at the 9^th IAS Conference on HIV Science (July 23-26). Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, the Swaziland PHIA, revealed impressive progress in confronting the HIV epidemic. Previously released survey results showed similar progress in three high-burden countries: Malawi, Zambia, and Zimbabwe.

The Kingdom of Swaziland has long had a severe HIV epidemic with the world’s highest national HIV prevalence and incidence (rate of new infections). The country has demonstrated a commitment to turning the tide of the epidemic by dramatically scaling up HIV testing and treatment as well as other prevention efforts. Between 2011, when SHIMS1 was conducted, and SHIMS2 in 2016, HIV incidence among adults fell by nearly half (2.5% to 1.4%) and the percentage of HIV-positive adults with viral load suppression (VLS), as a measure of control of the virus, doubled (35% to 71%). HIV prevalence among adults was stable at 30%, similar to the 2011 HIV prevalence of 32%.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

Leaders from across global health field expressed enthusiasm over the data. Wafaa El-Sadr, Director of ICAP at Columbia University, called the findings a “cause for celebration,” and Michele Sidibé, Executive Director of UNAIDS, said, “The best news of this conference will be the Swaziland results… The result should drive all our efforts.”

The Swaziland findings echo other PHIA results – released in December 2016 and expanded on through oral abstracts and posters presented at the IAS Conference.

Despite this substantial progress, significant work remains in order to further reach and engage men and young women, particularly around raising awareness of individual’s HIV-positive status and ensuring their access to effective treatment with high adherence.

The nationally representative PHIA surveys, implemented by ICAP in partnership with the US Centers for Disease Control and Prevention (CDC) and the ministries of health with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), provide valuable information on the state of HIV epidemics across Africa and help demonstrate measurable progress toward the UNAIDS 90-90-90 targets. In addition, the results provide further proof of how treatment works for prevention of HIV transmission.

“The partnership with the Swazi Ministry of Health was fundamental to the success of the survey,” said Shannon Hader, MD, MPH, director of the CDC’s Division of Global HIV & TB. “As we’ve seen in other countries, the PHIA findings will help the Ministry of Health and its partners to focus resources on urgent program priorities to achieve epidemic control.”

“We now have clear evidence that four African countries are approaching control of their HIV epidemics,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “These unprecedented findings demonstrate the remarkable impact of the U.S. government’s efforts, through PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, in partnership with African countries. We now have a historic opportunity to change the very course of the HIV pandemic.”

SHIMS2 Summary Sheet: Preliminary Findings, July 2017

July 25, 2017

Swaziland HIV Incidence Measurement Survey 2: A Population-Based HIV Impact Assessment

The Swaziland HIV Incidence Measurement Survey 2 (SHIMS2) was a household-based national survey conducted between August 2016 and March 2017 to measure the impact of Swaziland’s national HIV response on HIV incidence and viral load suppression. SHIMS2 offered household-based HIV counseling and testing with return of results and collected information about uptake of HIV care and treatment services. This is the second survey to estimate national HIV incidence and viral load suppression. Previous measurements were conducted in SHIMS1 in 2011.

Click the link below to view the results summary sheet.

SHIMS2 Summary Sheet: Preliminary Findings (Updated in November 2017)

Press Release: Swaziland Survey Shows Impressive Progress in Confronting the HIV Epidemic

July 24, 2017

PRESS RELEASE

CONTACTS:

Curran Kennedy
ICAP at Columbia University
ck2878@columbia.edu

PARIS, July 24, 2017

Key findings from the second Swaziland HIV Incidence Measurement Survey, SHIMS2, reveal impressive progress in confronting the HIV epidemic in the country. Results show a doubling in population viral load suppression since 2011 and a decrease by nearly half in the rate of new HIV infections. The findings were released today at a press conference held by the Prime Minister’s office in Mbabane, Swaziland and at the International Aids Society (IAS) 2017 Conference in Paris, France.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Senator Sibongile Ndlela-Simelane, the honorable Minister of Health, Swaziland. “The results of the SHIMS2 survey reveal a dramatic improvement in the state of the epidemic in Swaziland and we are very encouraged by this progress. We understand that the battle is not over, and therefore we must maintain the momentum.”

The data come from one of the population-based HIV impact assessment (PHIA) surveys led by the Government of the Kingdom of Swaziland (GKoS) through the Ministry of Health (MOH) and Central Statistical Office (CSO). The survey (SHIMS2) was implemented by ICAP at Columbia University and the US Centers for Disease Control and Prevention (CDC), with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR).

SHIMS2 is the second national incidence survey to be conducted in Swaziland, following the 2011 survey (SHIMS1) among adults 18-49 years of age.

In SHIMS2, over 14,000 children and adults participated in this nationally representative survey by agreeing to be interviewed and providing a blood sample for HIV testing.

Key SHIMS2 survey results include:

The annual rate of new HIV infections (“HIV incidence”) among adults ages 15 years and older was 1.36 percent: 1.70 percent among females and 1.02 percent among males. Among adults 18-49 years, HIV incidence was 1.39 percent, nearly half of the prior HIV incidence rate in 2011 2.48 percent.
The percentage of the adult population living with HIV (“HIV prevalence”) was 27.0 percent: 32.5 percent among females and 20.4 percent among males. The HIV prevalence among adults 18-49 years was 30.5 percent, similar to the 2011 HIV prevalence of 32.1 percent.
The percentage of all HIV-positive adults with viral load suppression (VLS), an indication that the infection is under control, was 73.1 percent: 76.0 percent among females and 67.6 percent among males. VLS was estimated using all people living with HIV (PLHIV) as a denominator, regardless of knowing their HIV status or use of antiretroviral drugs. Among all HIV+ adults aged 18-49 years, twice as many had VLS in SHIMS2 as compared to SHIMS1 (71.3 percent compared to 34.8 percent in 2011).
The percentage of all HIV-positive adults who knew their HIV status was 84.7%; of these individuals, 87.4% reported current use of antiretroviral treatment and, among those reporting treatment, 91.9 percent had VLS. These results indicate Swaziland has made substantial progress toward achieving all three of the “90-90-90’ targets set by UNAIDS to help end the HIV epidemic.

The progress represented by the findings is attributed to the expansion of HIV testing in the country as well as a substantial increase in the number of HIV-positive individuals on antiretroviral drugs from 2011 to 2016. This is combined with other HIV control interventions expanded in the country.

“These remarkable findings from Swaziland add to the evidence base that we are beginning to control the HIV epidemic in several high-burden countries,” said Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “They both demonstrate our extraordinary progress in ensuring that older HIV-positive adults are on life-saving treatment and virally suppressed as well as reveal key gaps that remain in reaching younger men and women with HIV services.”

“An amazing array of partnerships lasting over a decade – from collaboration within and between governments to coordination across international organizations and implementers – have brought us to an incredible level of success in the work on HIV and AIDS in Swaziland,” said Lisa J. Peterson, US Ambassador to Swaziland. “These partnerships are about people bringing their time and talents together to effect change. Thanks to these joint efforts, the SHIMS 2 data show that many more people will have the opportunity to share their own time and talents with their families and communities. It is especially important that we sustain and strengthen our collective engagement with Swaziland’s youth to ensure that we achieve an AIDS-free generation.”

“The findings from SHIMS2 are a testimony to the remarkable commitment by the Government of Swaziland in confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, director of ICAP. “It is a demonstration that all the efforts put into the scale-up of HIV prevention, care and treatment services have borne fruit. ICAP is honored to have played a role in helping to support this successful scale-up.”

“Each Population-based HIV Impact Assessment – PHIA – survey provides a ‘report card’ on how each country is doing in responding to its epidemic as well as a blueprint for future response,” said Jessica Justman, MD, ICAP’s senior technical director and principal investigator of all of ICAP’s PHIA projects, including SHIMS1 and SHIMS2. “Swaziland has made notable progress and is poised to continue making great strides forward with the implementation of test and start and ongoing scale-up of routine viral load monitoring. The SHIMS2 results will help focus efforts and prioritize specific populations in need of urgent attention and innovative approaches.”

Other collaborating governmental entities in Swaziland included the Health Research Unit, Swaziland Health Laboratory Services (SHLS), Swaziland National AIDS Program (SNAP), Health Promotion Unit, Health Management Information System, Environmental Health Department, and National Emergency Response Council on HIV/AIDS (NERCHA).

Additional details on SHIMS2 are available in the summary sheet released by the Swaziland Ministry of Health and the websites for the Ministry of Health www.gov.sz , CDC/PEPFAR www.cdc.gov and www.pepfar.gov, and ICAPs PHIA Project: phia.icap.columbia.edu.

About ICAP at Columbia University

ICAP was founded in 2003 at Columbia University’s Mailman School of Public Health. A global leader in HIV, tuberculosis, other health threats and health systems strengthening, ICAP provides technical assistance and implementation support to governments and non-governmental organizations. More than 2.2 million people have received HIV care through ICAP-supported programs and over 1.3 million have received antiretroviral therapy through such support.

New Population-Based HIV Impact Assessments (PHIA) Show Global Efforts are Helping to Control the HIV Epidemic

July 24, 2017

Findings from surveys in Swaziland, Zambia, Malawi, and Zimbabwe show remarkable progress toward HIV epidemic control, and confirm that global efforts are helping to curb the HIV epidemic and save lives. These Population-based HIV Impact Assessments (PHIA) are complex, national surveys, supported by CDC through the President’s Emergency Plan for AIDS Relief (PEPFAR), that provide critical information on the state of the HIV epidemic and response in countries affected by the disease. See more in the link below.

New Population-Based HIV Impact Assessments (PHIA) Show Global Efforts are Helping to Control the HIV Epidemic

And learn more at www.CDC.gov.

PHIA at IAS 2017: The Latest on Satellite Sessions, Oral Abstracts, and Poster Exhibitions

July 20, 2017

Join us to learn what the Population-based HIV Impact Assessment (PHIA) surveys data are telling us about the evolving HIV epidemic. (Full details can be found here)

Featured satellite session speakers:

Ambassador-at-Large Deborah Birx, U.S. global AIDS coordinator
Shannon Hader, CDC director of the Division of Global HIV and TB
Jessica Justman, ICAP technical director
Peter Ghys, UNAIDS director of strategic information and evaluation
Harriet Nuwagaba-Biribinwoha, Research director, ICAP in Swaziland

Additional PHIA activities at IAS 2017:

Monday, July 24

Oral abstracts
11:00 a.m.–12:30 p.m.
Late Breaker Oral Abstract Session (Blue Amphitheater)

Substantial Progress in Confronting the HIV Epidemic in Swaziland: First Evidence of National Impact. R. Nkambule (# MOAX0204LB)

Tuesday, July 25

Oral abstracts
11:00 a.m.–12:30 p.m.
Hitting the First 90 Target: Lessons from Population-based Surveys –
Oral Abstract Session Track C, Prevention Science (Maillot Room)

Findings from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA): HIV prevalence, incidence and progress towards the 90-90-90 goals. D.T. Barradas (# TUAC0301)

Correlates of being outside the 90-90-90 cascade among adults ages 15-64 years in Zimbabwe. A. Hakim (# TUAC0302)

90-90-90 targets in HIV-positive women using results from MPHIA: a Malawi success story. N. Wadonda-Kabondo (# TUAC0303)

Children living with HIV in Malawi: first survey-based measurement of national pediatric HIV prevalence and viral suppression. S. Jonnalagadda (# TUAC0304)

Poster Exhibition
12:30–14:30 p.m. (Level 3)

Estimation of HIV incidence and the profile of incident cases in Zimbabwe Population Based Impact Assessment (ZIMPHIA) 2015- 2016 (# TUPEC0832)

Evidence from the Zimbabwe population HIV impact assessment on 90-90-90: a national and provincial call to action for the first 90 (# TUPEC0743)

Undiagnosed HIV is higher among urban residents, young adults and men: first findings from Malawi Population-based HIV Impact Assessment (MPHIA) (# TUPEC0841)

Is MPHIA survey a validation method for HIV spectrum estimates in Malawi? (# TUPEC0741) Closing the 90-90-90 Gap: ZAMPHIA, 2016 (# TUPEC0875)

Geographical distribution of HIV burden in Malawi: where is the gap in achieving the 3rd 90? (# TUPEC0877)

Unmet 90-90-90 targets among adolescent girls and young women living with HIV in Malawi (# TUPEC0876)

The PHIA Project is led by ICAP at Columbia University in partnership with the U.S. Centers for Disease Control and Prevention (CDC) and the Ministry of Health in each country. The project is funded through the U.S. President’s Emergency Plan for AIDS Relief (PEFPAR).

Turning the Corner on the HIV Epidemic: New PHIA Survey Results Announced at CROI 2017 Show Progress in Zimbabwe, Malawi, and Zambia

February 17, 2017

Newly released findings from national HIV surveys in Zimbabwe, Malawi, and Zambia reveal extraordinary progress in confronting the HIV epidemic. These three countries in Southern Africa have been heavily affected by HIV and now there are encouraging signs that the epidemics are going in the right direction.

The findings, presented on February 16 at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI), are from the PEPFAR-supported Population-based HIV Impact Assessment (PHIA) Project surveys. The surveys are led by each Ministry of Health, with technical assistance from ICAP at Columbia in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). Compared with previous estimates, the PHIA data show that the rate of new infections (incidence) is stabilizing or declining. In addition, more than half of all adults living with HIV, regardless of use of antiretroviral medication, have a suppressed viral load and for those on antiretroviral medication, viral suppression is close to 90 percent. “Taken together, these findings tell a coherent and remarkable story of progress,” said Dr. Jessica Justman, principal investigator. “We can see that Zimbabwe, Malawi, and Zambia are on track to hit the UNAIDS 90-90-90 targets by 2020.”

Understanding the true status of an HIV epidemic rests on accurate measures of HIV prevalence, HIV incidence, and viral load suppression. These critical estimates provide a “report card” on the control of the epidemic and indicate where resources should be channeled to enable continued progress toward the 90-90-90 targets. The PHIA Project provides such information by directly assessing all of these measures through household surveys.

“These results are gratifying evidence that the investment by PEPFAR and other donors, and the efforts of national HIV programs, are paying off. The data from the PHIA surveys provide greater insights on where to focus our collective efforts and resources going forward,” said Dr. Shannon Hader, director of the Division of Global HIV and Tuberculosis at CDC.

In Malawi, Zambia, and Zimbabwe, nationally representative groups of adults and children were recruited in each country in 2015-16. Across the three countries, a total of 76,000 adults and children from 34,000 selected households took part in interviews and provided blood samples for testing. Participants received their HIV test result from a trained counselor during the same visit.

Combined HIV prevalence across the three countries was 12.2 percent among adults ages 15-59 years and 1.4 percent among children ages 0-14 years. Combined HIV incidence among adults was 0.51 percent. The combined prevalence of viral suppression (HIV RNA <1000 c/ml) among all HIV-positive adults, irrespective of knowledge of their HIV status, was 61.8 percent. Achievement of the “first 90 target” across the three countries—i.e., prior knowledge of status among those found to be HIV-positive during the survey—was 70 percent; the “second 90 target”—i.e., the percentage of those aware of their HIV-positive status who report current use of antiretroviral therapy (ART)—was 87 percent; and the “third 90 target”—i.e., the percentage among those who report current ART who had HIV viral suppression—was 89 percent. Less progress has been made toward the 90-90-90 targets among adolescents and young adults compared to older adults.

“These results reflect successful HIV care and treatment programs in each country,” said Dr. Wafaa El-Sadr, Director of ICAP. “Now more than ever, we have to keep our foot on the pedal and push even harder. Targeted testing, especially for adolescents and young adults, and continued expansion of HIV treatment programs and other prevention interventions for all will be critical to achieve ultimate epidemic control.”

A webcast of Dr. Justman’s CROI presentation is available on the CROI website: http://www.croiwebcasts.org/p/2017croi/croi33590

New Findings from the PHIA Project Show Significant Progress Against HIV in Africa

December 1, 2016

Preliminary results from the PHIA Project are now available for Zimbabwe, Malawi, and Zambia, and the news is excellent. The new data show exceptional progress against the HIV epidemic: rates of new infection are down, the number of people living with HIV is stable, and over half of all people living with HIV are on antiretroviral treatment and virally suppressed.

“The effects of HIV have been far-reaching. But these outcomes affirm that global, country and U.S.-supported HIV efforts have been successful to date, and that strong progress is being made across the entire HIV continuum of care,” said Ambassador Deborah Birx, U.S. Global AIDS Coordinator.

A five-year, multi-country initiative funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through U.S. Centers for Disease Control and Prevention (CDC), and led by ICAP at Columbia University, the PHIA surveys are implemented in collaboration with CDC and the Ministry of Health and other partners in each country. The Project deploys nationally representative household surveys to collect information related to HIV and offer in-home HIV counseling and testing by trained survey staff, with immediate return of results. It also conducts laboratory tests to characterize the HIV epidemic in adults and children and to measure reach and access to prevention, care and treatment services in each country.

The PHIA surveys are also measuring progress toward the UNAIDS 90-90-90 targets: that by 2020, 90 percent of all people living with HIV will know their HIV status, 90 percent of all people diagnosed with HIV will receive treatment, and 90 percent of all people on treatment achieve viral load suppression. This would translate to 73 percent of all HIV-positive people being virally suppressed.

“The Population-based HIV Impact Assessments are a powerful new tool in that they paint the clearest picture to date of the HIV epidemic in several sub-Saharan countries. New findings from Malawi, Zambia, and Zimbabwe validate what we have only been able to previously predict in models – that our global efforts are having a measurable impact in countries with some of the most severe HIV epidemics,” said Dr. Shannon Hader, director of the CDC Division of Global HIV and Tuberculosis.

PHIA and HIV Incidence

PHIA is the first effort to measure the national rate of new HIV infections, or HIV incidence, in the three countries. “The survey was designed to identify the rate of new infections at the national level, as well as to estimate the number of people living with HIV,” said Dr. Jessica Justman, PHIA principal investigator and senior technical director at ICAP. “This information is critically important to determining future resource needs.”

Conducted between October 2015 and August 2016, the first three surveys found that HIV incidence is lower than previously estimated and well below 1 percent in each country. The PHIA data estimate HIV incidence

In Zimbabwe as 0.45 percent (ages 15 to 64)
In Malawi as 0.37 percent (ages 15 to 64)
In Zambia as 0.66 percent (ages 15 to 59)

Compared to the 2003 incidence estimates between 1.3 and 1.5 percent per year for the same three countries, the current rate of new HIV infections has been cut in half during the past 13 years, when effective HIV treatment became available in sub-Saharan Africa, largely through support from PEPFAR.

PHIA and HIV Prevalence

HIV prevalence, or the percentage of people living with HIV, was measured for adults and children, and is similar to 2010 estimates. In addition to validating what has only been predicted previously in models, the surveys also provide new information, including the first measurements of pediatric HIV prevalence in Malawi and Zambia.

In Zimbabwe, prevalence among adults ages 15 to 64 is 14.6 percent, and is 1.6 percent among children ages 0 to 14.
In Malawi, prevalence among adults ages 15 to 64 is 10.6 percent, and is 1.6 percent among children ages 0 to 14.
In Zambia, prevalence among adults ages 15 to 59 is 12.3 percent, and is 1.3 percent among children ages 0 to 14.

These three countries continue to bear a substantial HIV burden, however, with prevalence stabilizing, the PHIA survey results suggest that people living with HIV are living longer thanks to effective and accessible treatment.

PHIA and Viral Load Suppression

The survey also conducted viral load testing for HIV-positive participants, which measures the number of HIV particles in a milliliter of blood to assess the effectiveness of antiretroviral therapy (ART). Viral load suppression (VLS) is a measure of well-controlled HIV infection. Among HIV-positive adults in the first three PHIA countries, prevalence of VLS was:

60.4 percent for those ages 15 to 64 in Zimbabwe
67.6 percent among those ages 15 to 64 in Malawi
59.8 percent among those ages 15 to 59 in Zambia

“It is heartening to see the impressive viral suppression noted in the three countries among those on treatment,” said Dr. Wafaa El-Sadr, director of ICAP. “ Viral suppression is critical for the well-being of people living with HIV and for preventing HIV transmission to others.”

PHIA and 90-90-90

Preliminary PHIA data show that Zimbabwe, Malawi, and Zambia have made great strides in responding to their HIV epidemics. While increases in testing are needed to ensure that all people living with HIV know their status, the PHIA results show that Zimbabwe, Malawi, and Zambia are close to achieving the global targets for, treatment, and VLS.

74.2 percent of PLHIV ages 15 to 64 in Zimbabwe report knowing their status, 86.8 percent of those individuals self-report being on ART, and 86.5 percent of that group are virally suppressed
72.7 percent of PLHIV ages 15 to 64 in Malawi report knowing their status, 88.6 percent of those individuals self-report being on ART, and 90.8 percent of that group are virally suppressed
67.3 percent of PLHIV ages 15 to 59 in Zambia report knowing their status, 85.4 percent of those individuals self-report being on ART, and 89.2 percent of that group are virally suppressed

“These data suggest that, in the areas surveyed, we are making encouraging progress towards global targets for people on HIV treatment and virally suppressed. And although we’ve made great strides, these findings indicate we still need to do more to help ensure people living with HIV are reached with life-saving services,” said Dr. Hader of the CDC.

Looking Forward

The PHIA data offer critical evidence to inform global and national HIV programs and investments in order for progress to be sustained and built upon. However, achieving this will require continued expansion of HIV treatment programs and increased testing for all people, especially men and young women.

“Importantly, the PHIA surveys clearly point to what still needs to be done, who we need to reach, and where we must focus our efforts, in order to build on these achievements,” Ambassador Birx added. “The findings will guide an effective response to the epidemic.”

From Arm to Freezer: PHIA Project Laboratory Network Supports Ambitious HIV Testing Targets

August 18, 2016

How can a large public health survey in sub-Saharan Africa collect blood samples efficiently? Is it possible to perform sophisticated lab tests in people’s homes? What is the best way to transport samples collected from remote locations? The Population-based HIV Impact Assessment (PHIA) Project, which relies on laboratory testing of blood samples as a core component, is providing answers to these questions. Led by ICAP at Columbia University, the PHIA surveys will assess the HIV epidemic in 13 select countries located primarily in sub-Saharan Africa. Fieldwork is nearly complete in three countries, with ten more national surveys to follow over the next two to three years. The surveys depend on well-trained staff and sufficient laboratory infrastructure to collect, test, and transport blood from individuals in approximately 15,000 households in each country.

Conducted in partnership with ministries of health and the Centers for Disease Control and Prevention (CDC), with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the PHIA Project draws on the expertise of ICAP and its partners for all aspects of its laboratory activities, from facility selection to staff training, laboratory setup, and quality assurance. Critical support in these areas has come from the CDC’s International Laboratory Branch, which builds sustainable laboratory capacity in PEPFAR-supported countries.

Currently, throughout Zimbabwe, Malawi, and Zambia, PHIA survey teams are visiting thousands of households to collect blood samples and perform rapid HIV tests, point-of-care CD4 tests, and in some countries, hepatitis B and syphilis rapid tests. While many other population-based surveys have collected a few drops of blood through a finger prick, the PHIA surveys collect two test tubes of blood from a vein in order to have both whole blood and plasma for testing. Participants receive test results within minutes, in the privacy of their homes. But that is not the final stop for each blood sample.

Quality assurance testing is performed in nearby satellite laboratories to ensure that the initial field test results are accurate. “All HIV-positive samples are retested using the Geenius HIV-1/HIV-2 test in the satellite lab to confirm the results,” says Dr. Herbert Longwe, one of ICAP’s regional lab advisors for the PHIA Project. “We also retest the first 50 of each field worker’s samples and 5 percent of all HIV-negative samples with the same rapid test kits to ensure accurate and trustworthy results.” Dried blood spots are prepared and then plasma and blood cells are separated, steps necessary for further testing. With a targeted “arm-to-freezer” time of less than 24 hours, the samples are then placed in a freezer and sent to a central lab for HIV incidence and HIV viral load testing, as well as for long-term storage.

The last steps in the testing process consist of specialized tests such as viral load testing to measure the quantity of HIV RNA in plasma, HIV incidence assays, DNA-PCR for HIV diagnosis in HIV-exposed infants, assays to detect antiretroviral agents, and HIV drug resistance testing. The two latter tests will be performed after survey completion at labs in several locations, including South Africa and Zimbabwe. The detailed data these additional tests provide can help improve HIV programming at local and national levels by indicating what percentage of people on treatment have achieved viral load suppression, a measure of whether they are on treatment and if treatment is working well.

To handle samples collected in remote locations in Zambia and Tanzania, PHIA teams are using mobile labs to ensure specimen quality. The mobile labs are fully equipped with a centrifuge, refrigerator, a -20⁰ C freezer, and basic supplies. “Mobile labs are an innovative way to handle samples when other labs are not close enough,” says Dr. Yen Pottinger, ICAP’s PHIA senior technical advisor for laboratory.

As part of the focus on high-quality testing and processing of PHIA samples, the PHIA team conducts instrument verification and assay validation to ensure tests are accurate and reliable. Working together, CDC’s International Lab Branch and ICAP monitor the accuracy of the HIV testing in the field and provide ongoing reviews to ensure each and every staff member’s proficiency with the techniques they learned in lab training.

“It was a challenge to create, but the PHIA Project now has a simple, workable quality assurance system in place, and this is one of the most exciting things I’ve seen in my career,” Longwe observes.

HIV viral load results are returned to a health facility of the participant’s choice, where they can consult with a health care provider to interpret the results and gain a greater understanding of their health status. Providing these results to participants is another innovative aspect of the PHIA survey. “Viral load testing is not yet routinely available in many of the survey countries. By returning the results within about eight weeks, the PHIA Project is making it possible for HIV-positive individuals and their doctors to have access to important clinical data to help manage their treatment,” says Pottinger.

PHIA’s complex network of satellite labs is helping the survey teams perform a high volume of HIV tests at the community level—more than 30,000 in Zimbabwe since October, more than 23,000 in Malawi since November, and more than 27,000 in Zambia since March—with accuracy. The systems established by CDC and ICAP also demonstrate the benefits of strong partnerships for a large, complex project, and allow the PHIA Project to pave the way for future surveys to handle blood samples.

Behind the Numbers: a Biostatistician in the Field

June 14, 2016

AAfter graduation, biostatisticians with advanced degrees usually end up in an office or lab to work with abstract numbers and equations. For Joshua Kriger, MS ’14, the experience has been more tangible. As the statistical program manager for ICAP’s Population-based HIV Impact Assessment (PHIA) Project, he spent 17 days doing fieldwork in Zambia where he trained local staff on survey methods to measure progress in the fight against HIV.

Implemented in partnership with the U.S. Centers for Disease Control and Prevention, PHIA will assess the state of the HIV epidemic in more than a dozen countries in sub-Saharan Africa where the epidemic has claimed millions of lives. Providing the latest data on the number of people infected, the rate of new infections, and how many people are getting effective treatment, the PEPFAR-funded survey will arm policymakers with the best information to direct resources to the fight against HIV.

Kriger and Seamus Thompson, director of Mailman’s Statistical Analysis Center, work closely with the PHIA team to analyze data from these household surveys and generate reliable reports. Before they could start crunching the numbers, they needed a firmer understanding of the data collection process, necessitating Kriger’s 7,400-mile trip to Zambia.

In collaboration with the national ministry of health and central statistical office (similar to the U.S. Census Bureau), the PHIA survey teams will visit around 15,000 households in each country to administer questionnaires and offer onsite HIV testing and counseling. When someone tests positive for HIV, survey staff will refer them to care and treatment services.

Building Trust

During his time in Zambia, Kriger trained survey workers to collect data using mobile tablets. At the same time, he took home important lessons on the context of how the survey will be implemented.

HIV is a sensitive topic for many people, and researchers and others working to respond to the epidemic must often ask intimate questions to gather accurate information. Among other things, the PHIA survey asks respondents about their sexual behavior, including anal sex, multiple partners, and sex work, to help identify risk factors and areas where interventions may be most effective.

“We are coming into peoples’ homes and offering HIV testing and asking them very personal questions about their health and behaviors,” says Kriger. “A big part of the survey is establishing trust.”

By learning about potential issues, Kriger and his team of 10 biostatisticians are much better prepared to identify and account for any gaps in the data later on. “Interpreting the data requires an intimate knowledge of how the data were collected in the field,” says Kriger.

Done right, biostatistics is about much more than crunching the numbers. As Kriger attests, it takes a healthy dose of cultural literacy and empathy for the experience of those living in countries affected by HIV.

Supplies on Demand: Logistics Coordination for the Multi-Country PHIA Survey

May 23, 2016

Today, survey teams for the PHIA Project are at work in three countries and have tested more than 53,000 people for HIV. Funded by PEPFAR through the CDC, this multi-year project to conduct population-based HIV-impact assessments (PHIAs) will provide critical information on the state of the HIV epidemic in these countries and help shape policies and programs to confront the epidemic.

Currently, PHIA survey teams are conducting thousands of interviews and HIV tests as they travel throughout Zimbabwe, Malawi, and Zambia in 4×4 trucks loaded with supplies. Every single item the teams use, from butterfly needles and vacutainer tubes to clipboards and pens, has arrived in their hands through months of meticulously planned procurement, transport, and inventory management. As the project prepares to start new surveys in Uganda, Tanzania, Swaziland, and Lesotho, logistics are a central focus of activities. “The project requires a unique combination of team talent, as well as supplies, and that must be available for consumption at remote locations,” says Charles Wentzel, ICAP’s PHIA regional procurement and logistics advisor.

Nearly every aspect of the survey fieldwork, including transportation of teams, laboratory testing, and training, relies on well-functioning equipment and adequate supplies to meet the survey targets. Given the scale of the project, which will survey between 20,000 and 30,000 people in each country, precise coordination is essential to delivering everything when and where it is needed. “There is a lot of information needed well ahead of time,” says Wentzel. Since most items are procured internationally, orders must be placed far in advance. The team factors in three months for shipping by sea, as well as customs clearances.

For each PHIA country, the ministry of health, the CDC, and ICAP work together to complete a planning worksheet. The team enters information onto the worksheet such as the number of households, expected HIV prevalence, specific lab tests, survey team composition, number of satellite labs, number of vehicles, and other parameters, and the worksheet then calculates the quantity needed for each item. David Hoos, PHIA project director, recalls that “ICAP first implemented a complex procurement tool during the implementation of the MTCT-Plus Initiative in 2002, for antiretroviral medication quantification.”

In some cases, mobile laboratories must be procured. This is necessary when blood samples will be collected from participants who are too far from any existing lab to meet the cold-chain or “arm-to-freezer” time requirements. In Zambia ICAP is using mobile laboratories which can process specimens and are equipped with refrigerators to ensure the samples and supplies are kept cold.

A customized logistics plan is necessary for each country and it reflects geography, weather, cultural, and political factors. Each factor may affect the specific equipment and supplies needed, the timing of the survey and transport of samples back to the lab, and time needed for customs clearance of imported supplies. Wentzel adds that, “addressing urgent or unforeseen challenges like delays, really comes down to the capacity of our team and the capacity of our system. Our team is experienced and can handle emergencies because they know what needs to be done.”

At the country level, the local logisticians are often lab technicians who understand the unique properties of PHIA supplies, particularly cold-chain items that may spoil. These technicians are trained in logistics functions and warehouse procedures. Some products have long production lead times, yet short expiry dates, further complicating the efforts to avoid ruptures in stock. Distribution of supplies is planned at multiple levels, with the warehouse providing stock to labs, and labs ensuring the field teams are fully equipped.

Tracking inventory is an essential function for the logisticians. The tracking mechanism itself is a user-friendly online system through which the in-country warehouse officer makes updates. Multiple people can access this in real time, so it allows simultaneous updating and tracking. The real-time aspect of the system is crucial for ensuring the field teams can work and move efficiently.

As the PHIA Project expands operations further, with four more countries starting data collection in 2016, the logistics teams are constantly implementing lessons learned. “We’re strengthening systems and enhancing ease of use for the upcoming surveys,” says Wentzel. “The system is changeable and we can make adjustments according to need.”

The PHIA Project is a multi-country initiative to measure the reach and impact of HIV programs in PEPFAR-supported countries and guide policy and funding priorities.

ZAMPHIA: Educating a Community about HIV

March 16, 2016

As the headmaster and only teacher at the Ndondo Community School in the rural Mongu District of Zambia in Western Province, Mr. Lambi Chingumbe educates the children of his community on math, English, and science. In addition, he is educating his community as a community mobilizer for the Zambia Population-based HIV Impact Assessment (ZAMPHIA) survey, showing his commitment to improving people’s health through knowledge.

“It is important to know your HIV status. Then you can start taking medicine early and live longer,” says Mr. Chingumbe.

Through in-home interviews and HIV counseling and testing, the ZAMPHIA survey is yielding essential national data on HIV in Zambia. The survey has a direct benefit for participants, and also serves a wider public health purpose. It will enable the Ministry of Health to better understand the impact of HIV at this stage of the global epidemic and target its treatment and prevention efforts at the national and community levels. In 2014, HIV prevalence among adults in Zambia was estimated at 12.4 percent. The country has made important strides in its response to HIV, reducing the rate of maternal HIV transmission from 24 percent to less than nine percent in the last five years. It has also increased the number of people tested for HIV by 20 percent between 2013 and 2014.

The survey began on March 1 and since then, 32 ZAMPHIA survey teams across Zambia’s Northern and Western provinces have been visiting selected households and providing HIV testing to adults and children who agree to participate. Before the teams arrive, community mobilizers like Mr. Chingumbe play a critical role in raising awareness of the survey and its importance. These local residents distribute brochures, talk to neighbors and organize community events. They are trained to address key project challenges and community concerns, including questions about HIV testing, how blood samples will be collected, and how participants’ personal information will be used. With a goal of reaching 16,000 households throughout the country, the community mobilizers are vital to the success of the survey.

Since December, 275 community mobilizers have been preparing for the arrival of ZAMPHIA in three provinces, under the direction of community mobilization coordinators. ”The coordinators are an essential link among the communities, the survey teams, and the broader ZAMPHIA team. Throughout the survey period they support the mobilizers in planning activities, monitoring community feedback, and responding to questions and issues that emerge,” says Kumbutso Dzekedzeke, ICAP’s ZAMPHIA project director.

Mr. Chingumbe says the most frequent question that arises from the community members is what kind of support is available if someone tests positive for HIV. The ZAMPHIA survey teams, who are trained in confidentiality procedures, provide HIV test results on the spot as well as pre- and post-test counseling, and they refer individuals who test positive to a local health center for care and support.

To Mr. Chingumbe, the work is an extension of his role as an educator in the community. “ZAMPHIA is here to help people know their status and help them see their children grow as well as to provide counseling and give lessons on how people can care for themselves.”

In this rural community, “most people work in the morning, so [we] go to the village around 2 PM when people are back from work.” This approach allows Mr. Chingumbe and the data collection team to maximize the number of survey participants. Community mobilization activities began in Mongu District in late December, and a few weeks into the effort, Mr. Chingumbe reported that the community response has been positive, and that people were eager for the survey to start.

“Tapping into the community mobilizers’ local knowledge is critical for securing high rates of participation,” says Mr. Dzekedzeke.

Zambia’s ZAMPHIA survey, the third PHIA survey to launch, is part of the PHIA Project, led by ICAP in partnership with the U.S. Centers for Disease Control and Prevention. The project is measuring the reach and impact of HIV programs in selected countries receiving support from the President’s Emergency Plan for AIDS Relief by estimating HIV prevalence, incidence, and viral load suppression among a nationally representative sample of adults and children in each country. The results of these surveys will guide national and global HIV programs, as well as policy and funding priorities.