Keerti Gedela

Research, with different methodologies, provided HIV care-cascade data within diverse settings; the UK, USA, countries in Southern Africa and Malawi. Data highlighted unmet needs of populations living with/affected by HIV, data gaps and country successes across the HIV care continuum. Additionally, it highlights some strengths and weaknesses of methodological approaches.

1) The UK Health Security Agency used novel methodology to explore the number of people with transmissible HIV in England, arguing that the UNAIDS 95-95-95 metric masks this, by excluding those not in care/missing information. Their approach estimated 24% (~15,000) of people living with transmissible HIV infection to be undiagnosed compared to over half using the UNAIDS metric 2) A study examined characteristics associated with viral suppression among transgender women living with HIV in 7 U.S cities. Among 1561 women taking part in surveys/blood testing for HIV/viral load, 659 tested positive for HIV (42%). Not being virally suppressed on ART was associated with younger age, homelessness, black ethnicity and unmet healthcare needs. 3) Patience Nyakato presented data on mortality in children living with HIV (from ART start) accounting for those lost to follow-up. Databases from Lesotho, Malawi, Mozambique, Zambia, Zimbabwe and South Africa were examined. Mortality was ~5% and 8%; after correction for LTFU, 7% and 12%. 4) A study recruiting >23,000 participants via household/blood sampling surveys, highlighted successes across the HIV cascade in Malawi. HIV prevalence (8.9%) declined by 1.7% (2016/2016); ART use among people living with HIV increased (97.8%). Population V/L suppression increased but was lowest among 15-24year-olds

This session highlighted several important data and context lessons; - Differences in data capturing structures globally and how they translate to data accuracy - Need to refine research methodology to enable more accurate big data to inform interventions - In settings with high LTFU rates and challenges to enable comprehensive record systems to track patients, accurate data is limited. However, the research from southern Africa described methodology that demonstrated higher rates of mortality when accounting for children LTFU - Looking beyond social/behavioural grouping to understand the wider social determinants that drive marginalisation and risk of poor retention in HIV care.