Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie/BCPP): a cluster-randomised trial

Wirth, Kathleen; Gaolathe, Tendani; Holme, Molly Pretorius; Mmalane, Mompati; Kadima, Etienne; Chakalisa, Unoda; Manyake, Kutlo; Mbikiwa, Atang Matildah; Simon, Selebaleng; Letlhogile, Rona; Mukokomani, Kutlwano; Widenfelt, Erik van; Moyo, Sikhulile; Bennett, Kara; Leidner, Jean; Powis, Kathleen M.; Lebelonyane, Refeletswe; Alwano, Mary Grace; Jarvis, Joseph N; Dryden‐Peterson, Scott; Kgathi, Coulson; Moore, Janet; Bachanas, Pam; Raizes, Elliot; Abrams, William; Block, Lisa; Sento, Baraedi; Novitsky, Vlad; El-Halabi, Shenaaz; Marukutira, Tafireyi; Mills, Lisa; Sexton, Connie J.; Pals, Sherri; Shapiro, Roger; Wang, Rui; Lei, Quanhong; DeGruttola, Victor; Makhema, Joseph; Essex, M.; Lockman, Shahin; Tchetgen, Eric J. Tchetgen

doi:10.1016/s2352-3018(20)30103-x

Cited by 20 publications

(28 citation statements)

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“…Consequently, we were unable to attribute gains and outcomes in the intervention communities to our particular interventions. However, data from a sample of communities comparing ART coverage at study end in a sample of three intervention and three control communities showed significantly higher knowledge of HIV status and ART uptake in intervention communities [ 21 ]. Another limitation of the study was that the estimation of the number of HIV-positive persons living in these communities was derived by extrapolating to non-enumerated households and might have resulted in under or overestimation of coverage of knowledge of status.…”

Section: Discussionmentioning

confidence: 99%

To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach

et al. 2021

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Background Increasing HIV treatment coverage is crucial to reducing population-level HIV incidence. Methods The Botswana Combination Prevention Project (BCPP) was a community randomized trial examining the impact of multiple prevention interventions on population-level HIV incidence and was conducted from October 2013 through June 2017. Home and mobile campaigns offered HIV testing to all individuals ≥ age 16. All identified HIV-positive persons who were not on antiretroviral therapy (ART) were referred to treatment and tracked to determine linkage to care, ART status, retention in treatment, and viral suppression Results Of an estimated total of 14,270 people living with HIV (PLHIV) residing in the 15 intervention communities, BCPP identified 13,328 HIV-positive persons (93%). At study start, 10,703 (80%) of estimated PLHIV knew their status; 2,625 (20%) learned their status during BCPP, a 25% increase with the greatest increases occurring among men (37%) and youth (77%). At study start, 9,258 (65%) of estimated PLHIV were on ART. An additional 3,001 persons started ART through the study. By study end, 12,259 had initiated and were retained on ART, increasing coverage to 93%. A greater increase in ART coverage was achieved among men (40%) compared to women (29%). Of the 11,954 persons who had viral load (VL) test results, 11,687 (98%) were virally suppressed (HIV-1 RNA ≤400 copies/mL). Overall, 82% had documented VL suppression by study end. Conclusions Knowledge of HIV-positive status and ART coverage increased towards 95–95 targets with universal testing, linkage interventions, and ART. The increases in HIV testing and ART use among men and youth were essential to reaching these targets. Clinical trial number NCT01965470.

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Section: Discussionmentioning

confidence: 99%

To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach

et al. 2021

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“…For the meta‐analysis, 47 studies reported data on knowledge of positive serostatus [39,41,44,52–55,58,59,63–65,69,73,77,79–81,83,84,86,91,94,95,97,99,101,102,108,110–113,144,146,149,151,154,157,167,171,178,185,186,188,189], 43 studies reported data on ART use [35,36,39,47,51,55,60,62,67,70,83–85,95,97–99,104,105,107,108,112,142,144–146,148–150,154,161,162,166–168,170,171,181,184–186,188,189] and 74 studies reported data on viral suppression (Table 1 and Table A2) [33,34,37,38,40–43,45,46,48–50,55–57,61,66,68,71,72,74–76,78,82,84,87–90,92,93,95–97,100,103,106–109,143,146,147,149,152–156,158–161,163–165,169,171–177,179,180,182,183,...…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 81 studies were included in the meta‐analysis [33–113] and 29 studies were included in the meta‐synthesis [105,114–141]. Our updated searches identified 48 additional studies for the meta‐analysis [142–189] and 11 additional studies for the meta‐synthesis [190–200], most published in 2020.…”

Section: Resultsmentioning

confidence: 99%

“…For the meta‐analysis, 47 studies reported data on knowledge of positive serostatus [ 39 , 41 , 44 , 52 , 53 , 54 , 55 , 58 , 59 , 63 , 64 , 65 , 69 , 73 , 77 , 79 , 80 , 81 , 83 , 84 , 86 , 91 , 94 , 95 , 97 , 99 , 101 , 102 , 108 , 110 , 111 , 112 , 113 , 144 , 146 , 149 , 151 , 154 , 157 , 167 , 171 , 178 , 185 , 186 , 188 , 189 ], 43 studies reported data on ART use [ 35 , 36 , 39 , 47 , 51 , 55 , 60 , 62 , 67 , …”

Section: Resultsmentioning

confidence: 99%

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Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

et al. 2022

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Introduction:Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods: We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. Results and discussion: We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions: Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.

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“…In modeling the lifetime impact of averting an infection, the monthly probability of acquiring HIV after the trial period was from age-specific incidence rates observed in the trial’s CP intervention arm, ranging from 0.24 – 0.84/100 PY. 5 , 6 …”

Section: Methodsmentioning

confidence: 99%

Health Impact and Cost-Effectiveness of HIV Testing, Linkage, and Early Antiretroviral Treatment in the Botswana Combination Prevention Project

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et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:The Botswana Combination Prevention Project tested the impact of combination prevention (CP) on HIV incidence in a community-randomized trial. Each trial arm had ;55,000 people, 26% HIV prevalence, and 72% baseline ART coverage. Results showed intensive testing and linkage campaigns, expanded antiretroviral treatment (ART), and voluntary male medical circumcision referrals increased coverage and decreased incidence over ;29 months of follow-up. We projected lifetime clinical impact and cost-effectiveness of CP in this population.Setting: Rural and periurban communities in Botswana.Methods: We used the Cost-Effectiveness of Preventing AIDS Complications model to estimate lifetime health impact and cost of (1) earlier ART initiation and (2) averting an HIV infection, which we applied to incremental ART initiations and averted infections calculated from trial data. We determined the incremental cost-effectiveness ratio [US$/quality-adjusted life-years (QALY)] for CP vs. standard of care. Results:In CP, 1418 additional people with HIV initiated ART and an additional 304 infections were averted. For each additional person started on ART, life expectancy increased 0.90 QALYs and care costs increased by $869. For each infection averted, life expectancy increased 2.43 QALYs with $9200 in care costs saved. With CP, an additional $1.7 million were spent on prevention and $1.2 million on earlier treatment. These costs were mostly offset by decreased care costs from averted infections, resulting in an incremental cost-effectiveness ratio of $79 per QALY.Conclusions: Enhanced HIV testing, linkage, and early ART initiation improve life expectancy, reduce transmission, and can be cost-effective or cost-saving in settings like Botswana.

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Population uptake of HIV testing, treatment, viral suppression, and male circumcision following a community-based intervention in Botswana (Ya Tsie/BCPP): a cluster-randomised trial

Cited by 20 publications

References 22 publications

To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach

To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

Health Impact and Cost-Effectiveness of HIV Testing, Linkage, and Early Antiretroviral Treatment in the Botswana Combination Prevention Project

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