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We evaluated viraemic control in a community\u2010randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013\u20132018).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non\u2010controllers if they had a VL \u22652000 copies\/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs &lt;2000 with no ARV drugs detected at both visits. Non\u2010controllers who had ARV drugs detected at either visit were excluded from the analysis to minimize potential confounders associated with ARV drug access and uptake.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The final cohort included 126 viraemic controllers and 766 non\u2010controllers who had no ARV drugs detected. The prevalence of controllers among the 4072 persons assessed was 3.1% (95% confidence interval [CI]: 2.6%, 3.6%). This should be considered a minimum estimate, since high rates of ARV drug use in the parent study limited the ability to identify controllers. Among the 892 participants in the final cohort, controller status was associated with biological sex (female &gt; male, <jats:italic>p<\/jats:italic> = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV\u20102) status at study enrolment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>To our knowledge, this report presents the first large\u2010scale, population\u2010level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self\u2010reported data). This study identified a large cohort of HIV controllers and non\u2010controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26179","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T09:08:38Z","timestamp":1698397718000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Population\u2010level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART)"],"prefix":"10.1002","volume":"26","author":[{"given":"Wendy","family":"Grant\u2010McAuley","sequence":"first","affiliation":[{"name":"Department of Pathology Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estelle","family":"Piwowar\u2010Manning","sequence":"additional","affiliation":[{"name":"Department of Pathology Johns Hopkins University School of Medicine  Baltimore Maryland 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