The impact of universal test and treat on HIV incidence in a rural South African population: ANRS 12249 TasP trial, 2012-2016
type: Article
abstract: Background: The population impact of universal test and treat (UTT) on HIV transmission has not yet been evaluated. Methods: A cluster-randomized trial was implemented in 2x11 rural communities in KwaZulu-Natal, South Africa. All residents ≥16 years were offered rapid HIV testing and provided dried blood spots (DBS) during 6-monthly home-based survey rounds. HIV-positive participants were referred to cluster-based trial clinics to receive ART regardless of CD4 count (intervention arm) or according to national guidelines (control arm). Standard of care ART was also available in the Department of Health clinics. HIV incidence was estimated on repeat DBS using cluster-adjusted Poisson regression. Results: Between 03/2012 and 04/2016, 13,239 and 14,916 individuals (63% women, median age 30 years) were registered in the intervention and control arms. Contact frequency per round among registered individuals ranged from 64% to 83%, HIV ascertainment from 74% to 85%. Baseline HIV prevalence was 29.4%(95%CI 28.8-30.0), with 7,578 individuals identified as HIV-positive. 1,513(36%) of 4,172 HIV-positive individuals not previously in care linked to trial clinics within 6 months of referral. ART initiation in trial clinics at 3 months was 90.9%(576/634) and 52.3%(332/635) in the intervention and control arms; viral suppression (< 400 copies/mL) 12 months after ART initiation was 94.9%(300/316) and 94.2%(194/206), respectively. Overall ART coverage at entry was 31% and 36% in the intervention and control arms, reaching 41% in both arms by closing date. Repeat DBS tests were available for 13,693 individuals HIV-negative at baseline, yielding 461 seroconversions in 20,833 person-years (PY). HIV incidence was 2.16 per 100 PY (1.88-2.45) in the intervention arm and 2.26 (1.98-2.54) in the control arm (adjusted relative risk: 0.95 [0.82-1.10]). Severe adverse events rates were 3.4%(45/1,323) and 3.5%(57/1,604) in the intervention and control arms. Follow-up will be completed by 06/201…
presented at: 21st International AIDS Conference (AIDS 2016)
citation key: iwujiImpactUniversalTest2016
creator: Person
author list: Person
author list: ANRS 12249 TasP Study Group
creator: ANRS 12249 TasP Study Group
is part of: Proceedings
  publisher: communication orale n°FRAC0105LB
    type: Organization
    locality name: Durban
  date: 2016-07-22

Person
given name: Collins
surname: Iwuji

Person
given name: Joanna
surname: Orne-Gliemann

Person
given name: Eric
surname: Balestre

Person
given name: Joseph
surname: Larmarange

Person
given name: Rodolphe
surname: Thiébaut

Person
given name: Frank
surname: Tanser

Person
given name: Nonhlanhla
surname: Okesola

Person
given name: Thembisa
surname: Makowa

Person
given name: Jaco
surname: Dreyer

Person
given name: Kobus
surname: Herbst

Person
given name: Nuala
surname: McGrath

Person
given name: Till
surname: Bärnighausen

Person
given name: Sylvie
surname: Boyer

Person
given name: Tulio
surname: de Oliveira

Person
given name: Claire
surname: Rekacewicz

Person
given name: Brigitte
surname: Bazin

Person
given name: Marie-Louise
surname: Newell

Person
given name: Deenan
surname: Pillay

Person
given name: François
surname: Dabis

ANRS 12249 TasP Study Group
type: Organization