@article{fdi:010068181,
  title = {{U}ptake of home-based hiv testing, linkage to care, and community attitudes about art in rural {K}wa{Z}ulu-{N}atal, {S}outh {A}frica : descriptive results from the first phase of the anrs 12249 tasp cluster-randomised trial},
  author = {{I}wuji, {C}. {C}. and {O}rne-{G}liemann, {J}. and {L}armarange, {J}oseph and {O}kesola, {N}. and {T}anser, {F}. and {T}hiebaut, {R}. and {R}ekacewicz, {C}. and {N}ewell, {M}. {L}. and {D}abis, {F}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {T}he 2015 {WHO} recommendation of antiretroviral therapy ({ART}) for all immediately following {HIV} diagnosis is partially based on the anticipated impact on {HIV} incidence in the surrounding population. {W}e investigated this approach in a cluster-randomised trial in a high {HIV} prevalence setting in rural {K}wa{Z}ulu-{N}atal. {W}e present findings from the first phase of the trial and report on uptake of home-based {HIV} testing, linkage to care, uptake of {ART}, and community attitudes about {ART}. {M}ethods and {F}indings {B}etween 9 {M}arch 2012 and 22 {M}ay 2014, five clusters in the intervention arm (immediate {ART} offered to all {HIV}-positive adults) and five clusters in the control arm ({ART} offered according to national guidelines, i.e., {CD}4 count <= 350 cells/mu l) contributed to the first phase of the trial. {H}ouseholds were visited every 6 mo. {F}ollowing informed consent and administration of a study questionnaire, each resident adult (>= 16 y) was asked for a finger-prick blood sample, which was used to estimate {HIV} prevalence, and offered a rapid {HIV} test using a serial {HIV} testing algorithm. {A}ll {HIV}-positive adults were referred to the trial clinic in their cluster. {T}hose not linked to care 3 mo after identification were contacted by a linkage-to-care team. {S}tudy procedures were not blinded. {I}n all, 12,894 adults were registered as eligible for participation (5,790 in intervention arm; 7,104 in control arm), of whom 9,927 (77.0%) were contacted at least once during household visits. {HIV} status was ever ascertained for a total of 8,233/9,927 (82.9%), including 2,569 ascertained as {HIV}-positive (942 tested {HIV}-positive and 1,627 reported a known {HIV}-positive status). {O}f the 1,177 {HIV}-positive individuals not previously in care and followed for at least 6 mo in the trial, 559 (47.5%) visited their cluster trial clinic within 6 mo. {I}n the intervention arm, 89% (194/218) initiated {ART} within 3 mo of their first clinic visit. {I}n the control arm, 42.3%(83/196) had a {CD}4 count <= 350 cells/mu l at first visit, of whom 92.8% initiated {ART} within 3 mo. {R}egarding attitudes about {ART}, 93% (8,802/9,460) of participants agreed with the statement that they would want to start {ART} as soon as possible if {HIV}-positive. {E}stimated baseline {HIV} prevalence was 30.5%(2,028/6,656) (95% {CI} 25.0%, 37.0%). {HIV} prevalence, uptake of home-based {HIV} testing, linkage to care within 6 mo, and initiation of {ART} within 3 mo in those with {CD}4 count <= 350 cells/mu l did not differ significantly between the intervention and control clusters. {S}election bias related to noncontact could not be entirely excluded. {C}onclusions {H}ome-based {HIV} testing was well received in this rural population, although men were less easily contactable at home; immediate {ART} was acceptable, with good viral suppression and retention. {H}owever, only about half of {HIV}-positive people accessed care within 6 mo of being identified, with nearly two-thirds accessing care by 12 mo. {T}he observed delay in linkage to care would limit the individual and public health {ART} benefits of universal testing and treatment in this population.},
  keywords = {{AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{P}los {M}edicine},
  volume = {13},
  numero = {8},
  pages = {art. e1002107 [18 ]},
  ISSN = {1549-1676},
  year = {2016},
  DOI = {10.1371/journal.pmed.1002107},
  URL = {https://www.documentation.ird.fr/hor/fdi:010068181},
}