@article{fdi:010067455,
  title = {{A}ccess to {HIV} care in the context of universal test and treat : challenges within the {ANRS} 12249 {T}as{P} cluster-randomized trial in rural {S}outh {A}frica [+ supplementary files]},
  author = {{P}lazy, {M}. and {E}l {F}arouki, {K}. and {I}wuji, {C}. and {O}kesola, {N}. and {O}rne-{G}liemann, {J}. and {L}armarange, {J}oseph and {L}ert, {F}. and {N}ewell, {M}.{L}. and {D}abis, {F}. and {D}ray-{S}pira, {R}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction : {W}e aimed to quantify and identify associated factors of linkage to {HIV} care following home-based {HIV} counselling and testing ({HBHCT}) in the ongoing {ANRS} 12249 treatment-as-prevention ({T}as{P}) cluster-randomized trial in rural {K}wa{Z}ulu-{N}atal, {S}outh {A}frica. {M}ethods : {I}ndividuals ?16 years were offered {HBHCT}; those who were identified {HIV} positive were referred to cluster-based {T}as{P} clinics and offered antiretroviral treatment ({ART}) immediately (five clusters) or according to national guidelines (five clusters). {HIV} care was also available in the local {D}epartment of {H}ealth ({D}o{H}) clinics. {L}inkage to {HIV} care was defined as {T}as{P} or {D}o{H} clinic attendance within three months of referral among adults not in {HIV} care at referral. {A}ssociated factors were identified using multivariable logistic regression adjusted for trial arm. {R}esults : {O}verall, 1323 {HIV}-positive adults (72.9% women) not in {HIV} care at referral were included, of whom 36.9% (n=488) linked to care <3 months of referral (similar by sex). {I}n adjusted analyses (n=1222), individuals who had never been in {HIV} care before referral were significantly less likely to link to care than those who had previously been in care (<33% vs. >42%, p<0.001). {L}inkage to care was lower in students (adjusted odds-ratio [a{OR}]=0.47; 95% confidence interval [{CI}] 0.24-0.92) than in employed adults, in adults who completed secondary school (a{OR}=0.68; {CI} 0.49-0.96) or at least some secondary school (a{OR}=0.59; {CI} 0.41-0.84) versus ? primary school, in those who lived at 1 to 2 km (a{OR}=0.58; {CI} 0.44-0.78) or 2-5 km from the nearest {T}as{P} clinic (a{OR}=0.57; {CI} 0.41-0.77) versus <1 km, and in those who were referred to clinic after ?2 contacts (a{OR}=0.75; {CI} 0.58-0.97) versus those referred at the first contact. {L}inkage to care was higher in adults who reported knowing an {HIV}-positive family member (a{OR}=1.45; {CI} 1.12-1.86) versus not, and in those who said that they would take {ART} as soon as possible if they were diagnosed {HIV} positive (a{OR}=2.16; {CI} 1.13-4.10) versus not. {C}onclusions : {F}ewer than 40% of {HIV}-positive adults not in care at referral were linked to {HIV} care within three months of {HBHCT} in the {T}as{P} trial. {A}chieving universal test and treat coverage will require innovative interventions to support linkage to {HIV} care.},
  keywords = {{AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {AIDS} {S}ociety},
  volume = {19},
  numero = {1},
  pages = {art. 20913 [12  + annexes, 9 p.]},
  ISSN = {1758-2652},
  year = {2016},
  DOI = {10.7448/{IAS}.19.1.20913},
  URL = {https://www.documentation.ird.fr/hor/fdi:010067455},
}