Assessing sex differences in viral load suppression and reported deaths using routinely collected program data from...

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Sub-Saharan Africa has higher HIV testing and treatment access for women.
• Women may achieve better viral load suppression (VLS) than men.
• This study examines sex differences in VLS and death rates within HIV programs.

Purpose of the Study:

• To analyze sex-based disparities in viral load suppression (VLS) and mortality rates.
• To investigate outcomes for individuals on antiretroviral therapy (ART) in sub-Saharan Africa.
• To inform targeted interventions for improving HIV treatment outcomes in men.

Main Methods:

• Utilized routinely reported HIV program data from 21 sub-Saharan African countries.
• Included VLS and death data for individuals aged 15+ on ART (Oct-Dec 2020), disaggregated by sex and age.
• Employed linear mixed-model and negative binomial mixed-model regressions, adjusting for key covariates.

Main Results:

• Women exhibited higher mean VLS (93.0%) compared to men (92.0%).
• Men had significantly higher mean rates of reported deaths (2.37 vs. 1.51 per 1000) and deaths plus treatment interruptions (30.1 vs. 26.0 per 1000).
• Higher death rates among men persisted even after adjusting for VLS.

Conclusions:

• Men experience higher mortality rates on ART in sub-Saharan Africa, irrespective of VLS.
• Investigating differences in care-seeking, opportunistic infection management, and testing accessibility for men is crucial.
• Recommendations include enhanced testing options for men, such as CD4 count monitoring.