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Principal Investigator: Mary Kathryn Grabowski
Organization: JOHNS HOPKINS UNIVERSITY
Fiscal Year: 2024
Award: $578,396
Funding agency: National Institute of Allergy and Infectious Diseases
PROJECT SUMMARY
Despite rollout of Universal Test-and-Treat (UTT) in Africa, HIV incidence has declined only modestly with no
country on track to meet UNAIDS 2030 targets for epidemic control. Control efforts are challenged by both
“hard-to-engage” HIV-positive persons who remain viremic as well as HIV drug resistance (HIVDR) which has
prompted the recent rollout of dolutegravir (DTG). While UTT and DTG are likely to result in lower levels of
viremia and HIVDR, there is uncertainty about the magnitude and durability of their population-level impact.
Provision of UTT and DTG has been disrupted by the recent COVID-19 pandemic in Uganda and the social
distancing and mobility restrictions implemented to contain transmission. Here, we propose the Longitudinal
Viral Load and Epidemiological Watch (LONGVIEW) Study, a prospective assessment of the impact of COVID-
19 disruption on UTT and DTG programmatic outcomes, including durable population viral load suppression,
HIVDR, and HIV incidence in southcentral Uganda. This study will be nested within the Rakai Community
Cohort Study (RCCS), a population-based study of ~20,000 persons, aged 15-49, in 40 communities with HIV
prevalence ranging from ~9-40% and transmitted HIVDR ~20%. We propose to measure viral loads and
perform deep sequence viral phylogenetics on all HIV-seropositive participants over seven RCCS surveys
(n~3800 HIV+ per survey) from 2013-2025, spanning introduction of UTT in 2017, DTG in 2019 and COVID-19
in 2020. In Aim 1, ~18,500 HIV viral loads will be determined for all HIV-positive RCCS participants at all study
visits. Group-based multi-trajectory analysis will be used to assess viral load suppression over time and deep
sequence phylogenetic data from all viremic participants (>1,000 HIV copies/mL) will assess HIVDR. In Aim 2,
we will use quantitative and qualitative methods to assess the impact of COVID-19 on HIV treatment seeking,
utilization, and care provision. Specifically, we will identify HIV-positive individuals who report interruptions in
HIV care and conduct in-depth interviews to assess the extent and nature of ART care disruption. We will also
conduct focus group discussions and in-depth interviews with HIV service providers to assess the impact of
COVID-19 on provision of HIV care and treatment. In Aim 3, we will evaluate trends in HIV incidence and risk
of HIV transmission across the infection and care continuum before and after COVID-19 emergence. We will
use longitudinal RCCS data to estimate HIV incidence as well as HIV transmission risk within household-based
partnerships. Deep sequence viral phylogenetic data will be used to reconstruct directed transmission
networks and estimate the attributable fraction of transmissions across the care continuum. This study will
provide empirical data on the impact of the COVID-19 pandemic on population HIV virologic and incidence
outcomes in a “real-world” programmatic setting. The overarching goal of this study is to measure the
impact of COVID-19 on UTT services, longer-term HIV viremia, drug resistance, and HIV incidence to inform
HIV control and elimination strategies in Africa.
Terms: <AIDS><AIDS Virus><AIDS prevention><Access to Care><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Adherence><Adoption><Africa><African><Anti-HIV Positivity><Anti-HIV resistance><Anti-HIV resistant><COVID crisis><COVID detection><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 detection><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><COVID19 detection><CV-19><Caring><Cohort Studies><Communities><Concurrent Studies><Continuity of Care><Continuity of Patient Care><Continuum of Care><Coronavirus Infectious Disease 2019><Country><Data><Development><Diagnosis><Drug resistance><Drug resistance in HIV><Emergencies><Emergency Situation><Epidemiology><Failure><Focus Groups><Future><Goals><HIV><HIV Positive><HIV Positivity><HIV Prevention><HIV Seroconversion><HIV Seropositivity><HIV antibody positive><HIV drug resistance><HIV drug resistant><HIV/AIDS prevention><HTLV-III Seroconversion><HTLV-III Seropositivity><Health Care Providers><Health Personnel><Health Services Accessibility><Health Status><Health system><Healthcare Providers><Healthcare worker><Household><Human Immunodeficiency Viruses><Incidence><Individual><Infection><Integrase Inhibitors><Interruption><Interview><LAV-HTLV-III><Level of Health><Life Cycle><Life Cycle Stages><Lymphadenopathy-Associated Virus><Measures><Methods><NNRTI-resistance><NNRTI-resistant><Nature><Newly Diagnosed><Outcome><Participant><Patients><Pattern><Persons><Pharmacists><Phylogenetic Analysis><Phylogenetics><Physical distancing><Population><Population Attributable Risks><Population Study><Prevalence><Prevention program><Privatization><Qualitative Methods><Reporting><Resistance><Risk><SARS-CoV-2 detection><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Social Distance><Social Mobility><Source><Survey Instrument><Surveys><Testing><Time><Transmission><Uganda><Uncertainty><United States><Viral><Viral Burden><Viral Load><Viral Load result><Viremia><Virus-HIV><Visit><access to health services><access to services><access to treatment><accessibility to health services><aged><antiretroviral therapy><antiretroviral treatment><attributable fraction><availability of services><care access><care seeking><cohort><coronavirus detection><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 crisis><coronavirus disease 2019 detection><coronavirus disease 2019 effect><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 impact><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic impact><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease detection><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 impact><coronavirus disease-19 pandemic><coronavirus infectious disease-19><detect COVID><detect COVID-19><detect COVID19><detect SARS-CoV-2><detect coronavirus><detect coronavirus disease><detect severe acute respiratory syndrome coronavirus 2><developmental><doubt><drug resistant><drug resistant HIV><effects following the COVID-19 pandemic><epidemic containment><epidemic control><epidemic mitigation><epidemic response><epidemiologic><epidemiological><health care personnel><health care worker><health level><health provider><health service access><health services availability><health workforce><healthcare personnel><impact of the SARS-CoV-2 pandemic><life course><medical personnel><non-nucleoside reverse transcriptase inhibitor resistance><non-nucleoside reverse transcriptase inhibitor resistant><population based><population-based study><population-level study><prevention service><programs><prospective><qualitative reasoning><resistance to Drug><resistance to HIV drug><resistance to anti-HIV><resistance to non-nucleoside reverse transcriptase inhibitor><resistant><resistant to Drug><resistant to HIV drug><resistant to non-nucleoside reverse transcriptase inhibitor><response><service availability><service providers><severe acute respiratory syndrome coronavirus 2 detection><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><spatiotemporal><stay-at-home mandate><stay-at-home order><stay-at-home ordinance><stay-at-home policy><studies of populations><study of the population><transmission process><treatment access><treatment program><treatment provider><treatment services><trend><uptake><viraemia><viral sepsis><virusemia>