Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana

Abstract

BACKGROUND-The feasibility of reducing the population-level incidence of human immunodeficiency virus (HIV) infection by increasing community coverage of antiretroviral therapy (ART) and male circumcision is unknown.METHODS-We conducted a pair-matched, community-randomized trial in 30 rural or periurban communities in Botswana from 2013 to 2018. Participants in 15 villages in the intervention group received HIV testing and counseling, linkage to care, ART (started at a higher CD4 count than in standard care), and increased access to male circumcision services. The standard-care group also consisted of 15 villages. Universal ART became available in both groups in mid-2016. We enrolled a random sample of participants from approximately 20% of households in each community and measured the incidence of HIV infection through testing performed approximately once per year. The prespecified primary analysis was a permutation test of HIV incidence ratios.

What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?

“…Consistent with other African cohort studies, viral suppression among youth was lower than among older adults . Mobile populations in all the trials had lower rates of viral suppression compared to non‐mobile populations . Men had lower viral suppression rates than women at study start and only slightly lower rates of viral suppression than women at study end.…”

“…However, this concern was not realized: by the end of the studies, viral suppression rates for ART‐treated individuals were ≥87% across the studies. In the BCPP trial, 97% of persons in the measurement cohort in the intervention arm had viral suppression at study end, reflecting highly successful engagement in HIV care .…”

“…However, this concern was not realized: by the end of the studies, viral suppression rates for ART-treated individuals were ≥87% across the studies. In the BCPP trial, 97% of persons in the measurement cohort in the intervention arm had viral suppression at study end, reflecting highly successful engagement in HIV care [9]. Patient-centered care, including "friendly provider service, " flexible clinic hours, tiered tracking, and provider access via mobile phone [12]; b both intervention arms were pooled for HPTN 071 (PopART) for population viral suppression and HIV incidence; c option for ART delivery in community adherence groups.…”

“…Universal test and treat (UTT) intervention arms: baseline and end of study population-level viral suppression (A); Populationlevel viral suppression from country surveys[24,25] and in the intervention arms in the UTT trials (B)[7][8][9][10].…”

Liten effekt av universell testing og behandling for hiv i Afrika

“…I den andre studien ble 30 distrikter i Botswana randomisert til hivtesting, veiledning og antiretroviral behandling og omskjaering av menn eller standard oppfølging i fem år (2). Av rundt 12 600 personer var ca.…”