Table 1:
Patient characteristics
| Patients included in prevalence calculation (n=402 668) | Patients included in outcomes analyses (n=197 729) | |||
|---|---|---|---|---|
| First-line ART (n=399 684)* | Second-line ART (n=5986)* | First-line ART (n=197 071)* | Second-line ART (n=1616)* | |
| Age at ART initiation, years | 34 (28–41) | 39 (32–46) | 35 (28–42) | 39 (32–47) |
| Sex | ||||
| Male | 128 633 (32·2%) | 1891 (31·6%) | 58 566 (29·7%) | 485 (30·0%) |
| Female | 271 051 (67·8%) | 4095 (68·4%) | 138 505 (70·3%) | 1131 (70·0%) |
| Calendar year of ART initiation | ||||
| 2016 | 71 331 (17·8%) | 350 (5·8%) | 50 523 (25·6%) | 50 (3·1%) |
| 2017 | 68 934 (17·2%) | 596 (10·0%) | 48 023 (24·4%) | 149 (9·2%) |
| 2018 | 67 790 (17·0%) | 1172 (19·6%) | 46 680 (23·7%) | 308 (19·1%) |
| 2019 | 77 586 (19·4%) | 1845 (30·8%) | 41 855 (21·2%) | 454 (28·1%) |
| 2020 | 113 781 (28·5%) | 1782 (29·8%) | 9990 (5·1%) | 581 (36·0%) |
| 2021† | 262 (<0·1%) | 241 (4·0%) | ·· | 74 (4·6%) |
| Duration of follow-up on ART | 105·6 (52·7–185·3) | 85·0 (51·4–134·0) | 163·3 (107·0–218·0) | 82·1 (49·1–132·8) |
| NRTI exposure‡ | ||||
| TDF plus emtricitabine or lamivudine | 397 731 (99·5%) | 5039 (84·2%) | 196 530 (99·7%) | 1421 (87·9%) |
| Zidovudine plus lamivudine | 42 401 (10·6%) | 2706 (45·2%) | 28 694 (14·6%) | 688 (42·6%) |
| Abacavir plus lamivudine | 4226 (1·1%) | 1078 (18·0%) | 2589 (1·3%) | 307 (19·0%) |
| NNRTI exposure‡ | ||||
| Efavirenz | 195 529 (48·9%) | 1000 (16·7%) | 135 108 (68·6%) | 348 (21·5%) |
| Nevirapine | 47 889 (12·0%) | 511 (8·5%) | 32 199 (16·3%) | 155 (9·6%) |
| INSTI (eg, dolutegravir-based) exposure‡ | 375 200 (93·9%) | 3003 (50·2%) | 190 885 (96·9%) | 997 (61·7%) |
| Protease inhibitor exposure‡ | ||||
| Ritonavir-boosted lopinavir | ·· | 3903 (65·2%) | ·· | 1045 (64·7%) |
| Ritonavir-boosted atazanavir | ·· | 3671 (61·3%) | ·· | 978 (60·5%) |
| Viral load test results during follow-up§ | ||||
| 1¶ | 198 422 (49·6%) | 2823 (47·2%) | 425 (0·2%) | 511 (31·6%) |
| 2 | 93 136 (23·3%) | 1537 (25·7%) | 92 669 (47·0%) | 539 (33·4%) |
| 3 | 56 577 (14·2%) | 908 (15·2%) | 55 493 (28·2%) | 300 (18·6%) |
| ≥4 | 51 549 (12·9%) | 718 (12·0%) | 48 484 (24·6%) | 266 (16·5%) |
| Virological status at first viral load result ≥24 weeks on ART§ | ||||
| Virological suppression (≤50 copies per mL) | 290 441 (72·7%) | 3271 (54·6%) | 157 399 (79·9%) | 1137 (70·4%) |
| LLV (51–999 copies per mL)∥ | 63 832 (16·0%) | 1445 (24·1%) | 39 672 (20·1%) | 370 (22·9%) |
| 51–199 | 40 438 (63·4%) | 861 (59·6%) | 25 623 (64·6%) | 225 (60·8%) |
| 200–399 | 11 646 (18·2%) | 278 (19·2%) | 7211 (18·2%) | 57 (15·4%) |
| 400–999 | 11 748 (18·4%) | 306 (21·2%) | 6838 (17·2%) | 88 (23·8%) |
| Viral load non-suppression (≥1000 copies per mL)** | 45 411 (11·4%) | 1270 (21·2%) | ·· | 109 (6·7%) |
| Timing of first viral load, weeks§ | 44 (29–79) | 21 (5–39) | 53 (32–92) | 24 (9–41) |
| <24 weeks | ·· | 2621 (43·8) | ·· | 796 (49·3) |
| 24–52 weeks | 227 995 (57·0) | 2159 (36·1) | 95 884 (48·7) | 569 (35·2) |
| ≥52 weeks | 171 689 (43·0) | 1206 (20·1) | 101 187 (51·3) | 251 (15·5) |
| Documented dispense ratio | 63% (41–94) | 79% (55–100) | 56% (39–77) | 90% (61–100) |
Data are n (%), median (IQR), or % (IQR). Patient characteristics (age, sex, and calendar year of initiation) were measured at the start of the respective ART line, whereas all other values were measured during follow-up. ART=antiretroviral therapy. INSTI=integrase strand transfer inhibitor. LLV=low-level viraemia. NNRTI=non-nucleoside reverse transcriptase inhibitor. NRTI=nucleos(t)ide reverse transcriptase inhibitor. TDF=tenofovir disoproxil fumarate.
Patients were counted according to their ART regimen line at the time of viral load measurements and could contribute to counts of both first-line and second-line patients. Some patients who received second-line ART did not have any documented viral load results before the switch to second-line ART; therefore first-line and second-line counts do not sum to the total number of patients.
Includes patients who initiated ART in 2021 and met inclusion criteria with a sufficient number of viral load measurements after at least 24 weeks on ART.
Measured as cumulative exposure (ie, all regimens received) while on the respective regimen line.
Includes viral load results received while on the relevant line after at least 24 weeks on ART. For patients on second-line ART, the 24-week period includes previous exposure to first-line ART. All patients included in outcomes analyses who received second-line ART have at least one previous documented receipt of first-line ART. Viral load results received before the 24th week of ART were not included in analysis.
Patients with only one viral load result on the respective regimen line were included in outcomes analyses if they had at least two viral load results.
The proportion of patients within each LLV range was calculated using the total number of patients with LLV (51–999 copies per mL) as the denominator.
Includes patients without initial viral load non-suppression who switched from first-line to second-line ART and had viral load non-suppression at the first viral load result after ART regimen switch.