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type: UserItem
resource: Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial
access date: 2018-03-19 17:02:57
repository: ScienceDirect

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial
type: AcademicArticle
abstract: Summary Background Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. Methods We did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially ≤350 cells per μL and <500 cells per μL from January, 2015; control). Participants and investigators were not masked to treatment allocation. We used dried blood spots once every 6 months provided by participants who were HIV negative at baseline to estimate the primary outcome of HIV incidence with cluster-adjusted Poisson generalised estimated equations in the intention-to-treat population after 58 cluster-years of follow-up. This study is registered with ClinicalTrials.gov, number NCT01509508, and the South African National Clinical Trials Register, number DOH-27-0512-3974. Findings Between March 9, 2012, and June 30, 2016, we contacted 26 518 (93%) of 28 419 eligible individuals. Of 17 808 (67%) individuals with a first negative dried blood spot te…
pages: e116-e125
doi: 10.1016/S2352-3018(17)30205-9
citation key: iwujiUniversalTestTreat2018
short title: Universal test and treat and the HIV epidemic in rural South Africa
creator: Person
author list: Person
is part of: Issue
  date: March 1, 2018
  volume: 5
  issue: 3
  is part of: The Lancet HIV
    type: Journal
    short title: The Lancet HIV
    issn: 2352-3018

Person
given name: Collins
surname: Iwuji

Person
given name: Joanna
surname: Orne-Gliemann

Person
given name: Joseph
surname: Larmarange

Person
given name: Eric
surname: Balestre

Person
given name: Rodolphe
surname: Thiebaut

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