@article{fdi:010077311,
  title = {{T}emporal trends of population viral suppression in the context of {U}niversal {T}est and {T}reat : the {ANRS} 12249 {T}as{P} trial in rural {S}outh {A}frica},
  author = {{L}armarange, {J}oseph and {D}iallo, {M}. {H}. 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 {O}rne-{G}liemann, {J}. and {P}illay, {D}. and {D}abis, {F}. and {M}arch, {L}aura and {ANRS} 12249 {T}as{P} {S}tudy {G}roup},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {T}he universal test-and-treat ({UTT}) strategy aims to maximize population viral suppression ({PVS}), that is, the proportion of all people living with {HIV} ({PLHIV}) on antiretroviral treatment ({ART}) and virally suppressed, with the goal of reducing {HIV} transmission at the population level. {T}his article explores the extent to which temporal changes in {PVS} explain the observed lack of association between universal treatment and cumulative {HIV} incidence seen in the {ANRS} 12249 {T}as{P} trial conducted in rural {S}outh {A}frica. {M}ethods {T}he {T}as{P} cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based {HIV} counselling and testing ({RHBCT}) and referral of {PLHIV} to local {HIV} clinics in 2 x 11 clusters opened sequentially. {ART} was initiated according to national guidelines in control clusters and regardless of {CD}4 count in intervention clusters. {W}e measured residency status, {HIV} status, and {HIV} care status for each participant on a daily basis. {PVS} was computed per cluster among all resident {PLHIV} (>= 16, including those not in care) at cluster opening and daily thereafter. {W}e used a mixed linear model to explore time patterns in {PVS}, adjusting for sociodemographic changes at the cluster level. {R}esults 8563 {PLHIV} were followed. {D}uring the course of the trial, {PVS} increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). {T}hat increase was similar in both arms (p = 0.514). {I}n the final adjusted model, {PVS} increase was most associated with increased {RHBCT} and the implementation of local trial clinics (measured by time since cluster opening). {C}ontextual changes (measured by calendar time) also contributed slightly. {T}he effect of universal {ART} (trial arm) was positive but limited. {C}onclusions {PVS} was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative {HIV} incidence between arms. {T}he {PVS} gains due to changes in {ART}-initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. {T}he achievement of the 90-90-90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context-specific, are not properly addressed. {C}linical trial number: {NCT}01509508 (clinical{T}rials.gov)/{DOH}-27-0512-3974 ({S}outh {A}frican {N}ational {C}linical {T}rials {R}egister).},
  keywords = {{HIV} ; antiretroviral therapy ; sustained viral suppression ; retention in care ; population health ; {S}outh {A}frica ; {AFRIQUE} {DU} {SUD}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {AIDS} {S}ociety},
  volume = {22},
  numero = {10},
  pages = {art. e25402 [11 ]},
  ISSN = {1758-2652},
  year = {2019},
  DOI = {10.1002/jia2.25402},
  URL = {https://www.documentation.ird.fr/hor/fdi:010077311},
}