{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:16:51Z","timestamp":1791375411575,"version":"4.3.1"},"reference-count":49,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,11,22]],"date-time":"2020-11-22T00:00:00Z","timestamp":1606003200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U2GGH001226"],"award-info":[{"award-number":["U2GGH001226"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["P2BEP3_178602"],"award-info":[{"award-number":["P2BEP3_178602"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The global target for 2020 is that \u226590% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from the population\u2010based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross\u2010sectional household surveys. Data collection included structured interviews, home\u2010based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load &lt;1000\u00a0copies\/mL), nonsuppressed viral load (NVL; viral load \u22651000\u00a0copies\/mL), virologic failure (VF; ARVs present and viral load \u22651000\u00a0copies\/mL), interrupted ART (ARVs absent and viral load \u22651000\u00a0copies\/mL) and rates of switching to second\u2010line ART (protease inhibitors present) among PLHIV aged 15 to 59\u00a0years who participated in the PHIA surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe, initiated ART at least four months before the survey and were receiving ART at the time of the survey (according to self\u2010report or ARV testing). We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second\u2010line ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non\u2010disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts &lt;200\u00a0cells\/\u00b5L, but few (0.31% per year) switched to second\u2010line ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Countries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor\u2010 or integrase inhibitor\u2010based regimens may further reduce NVL prevalence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25631","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T01:29:03Z","timestamp":1606094943000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Prevalence of nonsuppressed viral load and associated factors among HIV\u2010positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population\u2010based nationally representative surveys"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4849-181X","authenticated-orcid":false,"given":"Andreas D","family":"Haas","sequence":"first","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"},{"name":"Institute of Social and Preventive Medicine (ISPM) University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Radin","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6754-6241","authenticated-orcid":false,"given":"Avi J","family":"Hakim","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Jahn","sequence":"additional","affiliation":[{"name":"Ministry of Health Malawi Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neena M","family":"Philip","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasi","family":"Jonnalagadda","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzue","family":"Saito","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7088-4556","authenticated-orcid":false,"given":"Andrea","family":"Low","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hetal","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0708-5353","authenticated-orcid":false,"given":"Amee M","family":"Schwitters","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Lesotho Maseru Lesotho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen","family":"Frederix","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Malawi Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Bello","sequence":"additional","affiliation":[{"name":"Ministry of Health Malawi Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B","family":"Williams","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharat","family":"Parekh","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karampreet","family":"Sachathep","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle T","family":"Barradas","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Zambia Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thokozani","family":"Kalua","sequence":"additional","affiliation":[{"name":"Ministry of Health Malawi Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sehin","family":"Birhanu","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9077-4429","authenticated-orcid":false,"given":"Godfrey","family":"Musuka","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Mugurungi","sequence":"additional","affiliation":[{"name":"Ministry of Health &amp; Child Welfare Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A","family":"Tippett Barr","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Sleeman","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd B","family":"Mulenga","sequence":"additional","affiliation":[{"name":"Ministry of Health Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyaw","family":"Thin","sequence":"additional","affiliation":[{"name":"Research Coordination Unit Ministry of Health Maseru Lesotho"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trong T","family":"Ao","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Eswatini Mbabane Swaziland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew C","family":"Voetsch","sequence":"additional","affiliation":[{"name":"Division of Global HIV and TB Center for Global Health CDC Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica E","family":"Justman","sequence":"additional","affiliation":[{"name":"ICAP at Columbia University, Mailman School of Public Health, Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,22]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Joint United Nations Programme on HIV\/AIDS (UNAIDS).90\u201090\u201090. An ambitious treatment target to help end the AIDS epidemic. UNAIDS;2014."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832b7dca"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000243"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002468"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"issue":"7","key":"e_1_2_9_7_1","article-title":"Monitoring and switching of first\u2010line antiretroviral therapy in adult treatment cohorts in sub\u2010Saharan Africa: Collaborative analysis","volume":"2","author":"Haas AD","year":"2015","journal-title":"Lancet HIV"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-8-200704170-00007"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25084"},{"key":"e_1_2_9_10_1","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection Recommendations for a public health approach","author":"World Health Organization","year":"2016"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6547a2"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25008"},{"key":"e_1_2_9_13_1","volume-title":"Swaziland HIV Incidence Measurement Survey 2 (SHIMS2) 2016\u20132017","author":"Government of the Kingdom of Eswatini","year":"2019"},{"key":"e_1_2_9_14_1","unstructured":"Ministry of Health Lesotho Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University.Lesotho Population\u2010based HIV Impact Assessment (LePHIA) 2016\u20132017: Final Report.Maseru Lesotho Atlanta Georgia and NewYork NewYork USA:Ministry of Health CDC and ICAP;2019."},{"key":"e_1_2_9_15_1","volume-title":"Malawi Population\u2010Based HIV Impact Assessment (MPHIA) 2015\u20132016: Final Report","author":"Ministry of Health, Malawi","year":"2018"},{"key":"e_1_2_9_16_1","volume-title":"Zambia Population\u2010based HIV Impact Assessment (ZAMPHIA) 2016. Final Report","author":"Ministry of Health, Zambia","year":"2019"},{"key":"e_1_2_9_17_1","volume-title":"Zimbabwe Population\u2010based HIV Impact Assessment (ZIMPHIA) 2015\u20132016: Final Report","author":"Ministry of Health and Child Care (MOHCC), Zimbabwe","year":"2019"},{"key":"e_1_2_9_18_1","unstructured":"RutsteinSO JohnsonKThe DHS Wealth Index. DHS Comp Reports No 6.2004;1\u201371."},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.16.1789"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.7.821"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.2307\/2074954"},{"issue":"357","key":"e_1_2_9_22_1","first-page":"46","article-title":"Comparison of Stopping Rules in Forward \u201cStepwise\u201d Regression","volume":"72","author":"Robert BB","year":"1977","journal-title":"J Am Stat Assoc"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a115101"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-014-0849-1"},{"issue":"12","key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0189055","article-title":"Socioeconomic position and ten\u2010year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy","volume":"12","author":"Flynn AG","year":"2017","journal-title":"PLoS One"},{"issue":"11","key":"e_1_2_9_26_1","first-page":"1","article-title":"Predictors of first\u2010line antiretroviral therapy failure amongst HIV\u2010infected adult clients at Woldia Hospital, Northeast Ethiopia","volume":"12","author":"Babo YD","year":"2017","journal-title":"PLoS One"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP3020"},{"issue":"4","key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"19666","DOI":"10.7448\/IAS.17.4.19666","article-title":"Clinical and socio\u2010demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART\u20101","volume":"17","author":"Labhardt ND","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1605-5"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001761"},{"key":"e_1_2_9_31_1","first-page":"20","volume-title":"Proceedings of the Survey Research Merhods Section of rhe American Statistical Association","author":"Rubin DBD","year":"1987"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119942283"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2393"},{"issue":"14","key":"e_1_2_9_35_1","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1097\/QAD.0b013e32832e05b2","article-title":"Switching to second\u2010line antiretroviral therapy in resource\u2010limited settings: comparison of programmes with and without viral load monitoring","volume":"23","author":"ART\u2010LINC of IeDEA Study Group","year":"2009","journal-title":"AIDS"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0171780"},{"key":"e_1_2_9_37_1","unstructured":"Ministry Of Health And Child Care (MoHCC).Zimbabwe HIV viral load scale\u2010up plan: 2015\u20132018. [cited 2020 Oct 21]. Available from:https:\/\/depts.washington.edu\/edgh\/zw\/vl\/project\u2010resources\/Viral_Load_Plan.pdf"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25010"},{"issue":"9","key":"e_1_2_9_39_1","first-page":"1227","article-title":"Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi\u2019s Option B+ Program","volume":"63","author":"Haas AD","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"4","key":"e_1_2_9_40_1","article-title":"Retention in care during the first 3 years of antiretroviral therapy for women in Malawi\u2019s option B+ programme: an observational cohort study","volume":"3","author":"Haas AD","year":"2016","journal-title":"Lancet HIV"},{"key":"e_1_2_9_41_1","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach","author":"World Health Organization","year":"2013"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70168-2"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit933"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31829f05ac"},{"key":"e_1_2_9_45_1","volume-title":"Interim guidelines. Updated recommedations on first\u2010line and second\u2010line antiretroviral regimens and post\u2010exposure prophylaxis and recommendations on early infant diagnosis of HIV","author":"World Health Organization","year":"2018"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001845"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy347"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12843"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ1004"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwaa049"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25631","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25631","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25631","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T01:02:24Z","timestamp":1693789344000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25631"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":49,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1002\/jia2.25631"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25631","archive":["Portico"],"relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.07.13.20152553","asserted-by":"object"}]},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11]]},"assertion":[{"value":"2020-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25631"}}