Antiretroviral drug use in a cross-sectional population survey in Africa: NIMH project accept (HPTN 043)

Jessica M. Fogel, William Clarke, Michal Kulich, Estelle Piwowar-Manning, Autumn Breaud, Matthew T. Olson, Mark A. Marzinke, Oliver Laeyendecker, Agnès Fiamma, Deborah Donnell, Jessie K.K. Mbwambo, Linda Richter, Glenda Gray, Michael Sweat, Thomas J. Coates, Susan H. Eshleman

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence. Methods: Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir). Results: ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors 6 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018). Conclusions: This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.

Original languageEnglish (US)
Pages (from-to)158-165
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number2
StatePublished - Feb 1 2017


  • Africa
  • Antiretroviral drug use
  • HIV

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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