Factors Associated with Unsuppressed Viral Loads Among Positive Partners Within HIV Sero-Discordant Couples and Population at Risk of Transmission -A Population-based Survey in Malawi, Tanzania, Zambia and Eswatini Open Access

Aboah Taylor, Akua (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/sn009z75h?locale=en


Introduction: Within-couple transmission among HIV sero-discordant couples make up a significant proportion of new HIV infections. Characteristics of sero-discordant couples associated with unsuppressed viral loads in the positive partner have been relatively underexplored. Our study aimed to identify individual and couple characteristics of sero-discordant couples associated with unsuppressed HIV viral loads and to estimate HIV negative partners at risk of being infected.

Methods: This was a cross-sectional study using data from Population-based Impact Assessment (PHIA) survey conducted in four Sub-Saharan African countries, namely Malawi, Tanzania, Zambia and Eswatini between, October 2015 and June 2017. We used weighted logistic regression analysis to identify factors associated with the HIV positive partner being virally unsuppressed. Individual interview weights were applied to estimate the number of HIV negative partners at risk of acquiring an infection from their positive partners.

Results: Of the 13,695 couples, 929(99.0%) were HIV sero-discordant and eligible for analysis. Among F-M+ couples, the odds of having unsuppressed viral loads was higher among HIV-positive male partners who were younger, between 25 to 34 years ( (Odds Ratio)OR-5.06 95% CI: 4.88-2.23), lived in urban regions(OR-1.28 95% CI: 1.26-1.31) and had not disclosed their HIV status to their partners(OR-4.46 95% CI:4.36-4.56). Among F+M- couples, the odds of being virally unsuppressed was higher in HIV positive females who were between the ages of 15 and 24(OR-2.24 95% CI:2.12-2.31) and had not disclosed their HIV status to their partners(OR-4.06 95% CI: 3.97-4.15); odds were lower among females if they lived in the urban areas(OR-0.93 95% CI 0.92-0.95).Both male and female HIV positive partners had higher odds of being unsuppressed if they had no formal education. An estimated 178,196 HIV-negative persons are at risk of acquiring HIV infection from their positive partners due to unsuppressed viral loads.

Conclusions: Our study findings demonstrate that a significant proportion of people living with HIV in sero-discordant relationships are not virologically suppressed, with negative partners who are at risk of acquiring HIV. We recommend that Pre-Exposure prophylaxis (PrEP) be scaled up among negative partners in this high-risk population, to reduce the risk of HIV transmission.

Table of Contents




Study Design and Population. 7

Data Collection and Selection Criteria. 7

Laboratory procedures. 8

Outcome Variable. 8

Explanatory variables. 8

Ethics and Training of staff. 9

Data Analysis. 9

Data Availability. 11


HIV-negative female with HIV-positive male partner (F- M+). 13

HIV-positive female with HIV-negative male partner (F+M-). 14

Partners at risk of transmission and awareness of HIV-positive status. 16


Strengths and Limitations. 19

Conclusion and Recommendations. 20




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