{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T22:01:37Z","timestamp":1783980097700,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"S5","license":[{"start":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T00:00:00Z","timestamp":1632182400000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01AI131895"],"award-info":[{"award-number":["K01AI131895"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI096299"],"award-info":[{"award-number":["U01AI096299"]}],"id":[{"id":"10.13039\/100000002","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":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The third of the Joint United Nations Programme on HIV\/AIDS (UNAIDS) 90\u201090\u201090 targets is to achieve a 90% rate of viral suppression (HIV viral load &lt;1000 HIV\u20101 RNA copies\/ml) in patients on antiretroviral treatment (ART) by 2020. However, some countries use different thresholds when reporting viral suppression, and there is thus a need for an adjustment to standardize estimates to the &lt;1000 threshold. We aim to propose such an adjustment, to support consistent monitoring of progress towards the \u201cthird 90\u201d target.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We considered three possible distributions for viral loads in ART patients: Weibull, Pareto and reverse Weibull (imposing an upper limit but no lower limit on the log scale). The models were fitted to data on viral load distributions in ART patients in the International epidemiology Databases to Evaluate AIDS (IeDEA) collaboration (representing seven global regions) and the ART Cohort Collaboration (representing Europe), using separate random effects models for adults and children. The models were validated using data from the World Health Organization (WHO) HIV drug resistance report and the Brazilian national ART programme.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Models were calibrated using 921,157 adult and 37,431 paediatric viral load measurements, over 2010\u20132019. The Pareto and reverse Weibull models provided the best fits to the data, but for all models, the \u201cshape\u201d parameters for the viral load distributions differed significantly between regions. The Weibull model performed best in the validation against the WHO drug resistance survey data, while the Pareto model produced uncertainty ranges that were too narrow, relative to the validation data. Based on these analyses, we recommend using the reverse Weibull model. For example, if a country reports an 80% rate of viral suppression at &lt;200 copies\/ml, this model estimates the proportion virally suppressed at &lt;1000 copies\/ml is 88.3% (0.80<jats:sup>0.56<\/jats:sup>), with uncertainty range 85.5\u201390.6% (0.80<jats:sup>0.70<\/jats:sup>\u20130.80<jats:sup>0.44<\/jats:sup>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Estimates of viral suppression can change substantially depending on the threshold used in defining viral suppression. It is, therefore, important that viral suppression rates are standardized to the same threshold for the purpose of assessing progress towards UNAIDS targets. We have proposed a simple adjustment that allows this, and this has been incorporated into UNAIDS modelling software.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25776","type":"journal-article","created":{"date-parts":[[2021,9,21]],"date-time":"2021-09-21T16:27:21Z","timestamp":1632241641000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Achieving consistency in measures of HIV\u20101 viral suppression across countries: derivation of an adjustment based on international antiretroviral treatment cohort data"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2717-011X","authenticated-orcid":false,"given":"Leigh F.","family":"Johnson","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Epidemiology and Research University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azar","family":"Kariminia","sequence":"additional","affiliation":[{"name":"Kirby Institute University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3462-2898","authenticated-orcid":false,"given":"Adam","family":"Trickey","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9014-3651","authenticated-orcid":false,"given":"Constantin T.","family":"Yiannoutsos","sequence":"additional","affiliation":[{"name":"Fairbanks School of Public Health Indiana University  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier K.","family":"Ekouevi","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Sant\u00e9 Publique, Facult\u00e9 des Sciences de la Sant\u00e9 Universit\u00e9 de Lom\u00e9  Lom\u00e9 Togo"},{"name":"Institut de Sant\u00e9 Publique, Epid\u00e9miologie et D\u00e9veloppement (ISPED) Universit\u00e9 de Bordeaux &amp; 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