Sustained Viral Suppression among People with HIV in the Era of Undetectable = Untransmittable (U = U) in Australia

INTRODUCTION:In Australia, cross-sectional estimates suggest that over 95% of people with HIV are virally suppressed; however, these measures reflect only the most recent viral load. Sustained viral suppression (SVS) is essential for optimizing health and preventing transmission. This study describes SVS among people with HIV who are engaged in care in Australia and factors associated with SVS. METHODS:We analyzed national data from the ACCESS sentinel surveillance system. Eligible participants attended an ACCESS clinic in 2023, received continuous antiretroviral therapy (ART; ≥1 prescription per calendar year), and had at least two viral load tests in the preceding three years (median:6; IQR: 5-7). SVS was defined as all viral load results less than 200 copies/ml. Multivariable logistic regression identified factors associated with SVS. RESULTS:Of 6036 eligible participants (95% men; median age 54 years), 5751 (95.3%) achieved SVS, while 99.1% were suppressed based on their last test. Older age (adjusted odds ratio [aOR]: 1.01; 95% confidence interval (95% CI): 1.002-1.03), residence in more socioeconomically advantaged areas (aOR: 1.06; 1.01-1.12), and higher mean CD4 + cell count (aOR: 1.00; 1.001-1.002) were associated with higher odds of SVS. Receiving care at publicly funded sexual health/hospital-based clinics (aOR:0.64; 0.48-0.86), more diagnoses of gonorrhea (aOR: 0.81; 0.67-0.96) or infectious syphilis in the last three years (aOR: 0.85; 0.73-0.98), and co-infection with hepatitis C in the last 3 years (aOR: 0.56; 0.36-0.87) were associated with lower SVS. CONCLUSIONS:More than 95% of people with HIV receiving ART and engaged in ongoing care achieved SVS. Strengthened, person-centered support for groups with lower SVS may enhance clinical outcomes and sustain Australia's progress toward HIV elimination goals.