BACKGROUND: Antiretroviral (ARV) drug treatment benefits the treated individual and can prevent HIV transmission. We assessed ARV drug use in a community-randomized trial that evaluated the impact of behavioral interventions on HIV incidence. METHODS: Samples were collected in a cross-sectional survey after a 3-year intervention period. ARV drug testing was performed using samples from HIV-infected adults at 4 study sites (Zimbabwe; Tanzania; KwaZulu-Natal and Soweto, South Africa; survey period 2009-2011) using an assay that detects 20 ARV drugs (6 nucleoside/nucleotide reverse transcriptase inhibitors, 3 nonnucleoside reverse transcriptase inhibitors, and 9 protease inhibitors; maraviroc; raltegravir). RESULTS: ARV drugs were detected in 2011 (27.4%) of 7347 samples; 88.1% had 1 nonnucleoside reverse transcriptase inhibitors ± 1-2 nucleoside/nucleotide reverse transcriptase inhibitors. ARV drug detection was associated with sex (women>men), pregnancy, older age (>24 years), and study site (P < 0.0001 for all 4 variables). ARV drugs were also more frequently detected in adults who were widowed (P = 0.006) or unemployed (P = 0.02). ARV drug use was more frequent in intervention versus control communities early in the survey (P = 0.01), with a significant increase in control (P = 0.004) but not in intervention communities during the survey period. In KwaZulu-Natal, a 1% increase in ARV drug use was associated with a 0.14% absolute decrease in HIV incidence (P = 0.018). CONCLUSIONS: This study used an objective, biomedical approach to assess ARV drug use on a population level. This analysis identified factors associated with ARV drug use and provided information on ARV drug use over time. ARV drug use was associated with lower HIV incidence at 1 study site.

*Department of Pathology Johns Hopkins University School of Medicine Baltimore MD; †Department of Probability and Statistics Faculty of Mathematics and Physics Charles University Prague Czech Republic; ‡Laboratory of Immunoregulation Division of Intramural Research National Institute of Allergy and Infectious Diseases National Institutes of Health Baltimore MD; §Department of Medicine Johns Hopkins University School of Medicine Baltimore MD; ‖Program in Global Health University of California at Los Angeles Los Angeles CA; ¶Vaccine and Infectious Disease Division Fred Hutchinson Cancer Research Center Seattle WA; Department of Global Health University of Washington Seattle WA; **Muhimbili University of Health and Allied Sciences Muhimbili University Teaching Hospital Dar es Salaam Tanzania; ††DST NRF Centre of Excellence in Human Development University of the Witwatersrand Johannesburg South Africa; ‡‡Perinatal HIV Research Unit Chris Hani Baragwanath Hospital University of the Witwatersrand Johannesburg South Africa; §§South African Medical Research Council Cape Town South Africa; ‖‖Department of Psychiatry and Behavioral Sciences The Medical University of South Carolina Charleston SC; and ¶¶Center for World Health David Geffen School of Medicine and UCLA Health Los Angeles CA

J Acquir Immune Defic Syndr. 2018 Apr 15;77(5):e48. doi: 10.1097/QAI.0000000000001672. PubMed

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