@article{fdi:010073698,
  title = {{T}he impact of population dynamics on the population {HIV} care cascade : results from the {ANRS} 12249 treatment as prevention trial in rural {K}wa{Z}ulu-{N}atal ({S}outh {A}frica)},
  author = {{L}armarange, {J}oseph and {D}iallo, {M}amadou {H}assimiou and {M}c{G}rath, {N}. and {I}wuji, {C}. and {P}lazy, {M}. and {T}hiebaut, {R}. and {T}anser, {F}. and {B}arnighausen, {T}. and {P}illay, {D}. and {D}abis, {F}. and {O}rne-{G}liemann, {J}. and {ANRS} {T}as{P} {S}tudy {G}roup},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction: {T}he universal test and treat strategy ({UTT}) was developed to maximize the proportion of all {HIV}-positive individuals on antiretroviral treatment ({ART}) and virally suppressed, assuming that it will lead to a reduction in {HIV} incidence at the population level. {T}he evolution over time of the cross-sectional {HIV} care cascade is determined by individual longitudinal trajectories through the {HIV} care continuum and underlying population dynamics. {T}he purpose of this paper is to quantify the contribution of each component of population change (in- and out-migration, {HIV} seroconversion, ageing into the cohort and definitive exit such as death) on the {HIV} care cascade in the context of the {ANRS} 12249 {T}reatment as {P}revention ({T}as{P}) cluster-randomized trial, investigating {UTT} in rural {K}wa{Z}ulu-{N}atal, {S}outh {A}frica, between 2012 and 2016. {M}ethods: {HIV} test results and information on clinic visits, {ART} prescriptions, viral load and {CD}4 count, migration and deaths were used to calculate residency status, {HIV} status and {HIV} care status for each individual on a daily basis. {P}osition within the {HIV} care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). {W}e compared the cascade score of each individual joining or leaving the population of resident adults living with {HIV} with the average score of their cluster at the time of entry or exit. {T}hen, we computed the contribution of each entry or exit on the average cascade score and their annualized total contribution, by component of change. {R}esults: {W}hile the average cascade score increased over time in all clusters, that increase was constrained by population dynamics. {P}ermanent exits and ageing into the people living with {HIV} cohort had a marginal effect. {B}oth in-migrants and out-migrants were less likely to be retained at each step of the {HIV} care continuum. {H}owever, their overall impact on the cross-sectional cascade was limited as the effect of in- and out-migration balanced each other. {T}he contribution of {HIV} seroconversions was negative in all clusters. {C}onclusions: {I}n a context of high {HIV} incidence, the continuous flow of newly infected individuals slows down the efforts to increase {ART} coverage and population viral suppression, ultimately attenuating any population-level impact on {HIV} incidence.},
  keywords = {{HIV} care continuum ; {P}ublic health ; {S}tructural drivers ; {M}igration ; {C}ross-sectional cascade ; {R}ural {S}outh {A}frica ; {P}opulation dynamics ; {AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {A}ids {S}ociety},
  volume = {21},
  numero = {4},
  pages = {e25128 [10 ]},
  ISSN = {1758-2652},
  year = {2018},
  DOI = {10.1002/jia2.25128},
  URL = {https://www.documentation.ird.fr/hor/fdi:010073698},
}