MF5F8M9J
type: UserItem
resource: Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial
access date: 2022-02-26 15:43:00
repository: Wiley Online Library
tagged: AutoTag
  label: HIV
tagged: AutoTag
  label: South Africa
tagged: AutoTag
  label: immediate antiretroviral therapy
tagged: AutoTag
  label: mortality
tagged: AutoTag
  label: test and treat

Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial
type: AcademicArticle
abstract: Objectives Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits. Methods The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial. Results Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85–1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28–0.85, p = 0.01), but not after the trial ended. Conclusions The ‘treat all’ strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.
pages: 922-928
doi: 10.1111/hiv.13263
citation key: baisleyEarlyHIVTreatment2022
short title: Treat-all strategy and long-term survival among people living with HIV in South Africa
language: en
extra: WOS:000761366200001 _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.13263
creator: Person
author list: Person
is part of: Issue
  date: 2022-02-26
  volume: 23
  issue: 8
  is part of: HIV Medicine
    type: Journal
    issn: 1468-1293

Person
given name: Kathy
surname: Baisley

Person
given name: Joanna
surname: Orne-Gliemann

Person
given name: Joseph
surname: Larmarange

Person
given name: Melanie
surname: Plazy

Person
given name: Dami
surname: Collier

Person
given name: Jaco
surname: Dreyer

Person
given name: Thobeka
surname: Mngomezulu

Person
given name: Kobus
surname: Herbst

Person
given name: Willem
surname: Hanekom

Person
given name: Francois
surname: Dabis

Person
given name: Mark J.
surname: Siedner

Person
given name: Collins
surname: Iwuji