@article{fdi:010078031,
  title = {{W}hat do the {U}niversal {T}est and {T}reat trials tell us about the path to {HIV} epidemic control ?},
  author = {{H}avlir, {D}. and {L}ockman, {S}. and {A}yles, {H}. and {L}armarange, {J}oseph and {C}hamie, {G}. and {G}aolathe, {T}. and {I}wuji, {C}. and {F}idler, {S}. and {K}amya, {M}. and {F}loyd, {S}. and {M}oore, {J}. and {H}ayes, {R}. and {P}etersen, {M}. and {D}abis, {F}. and {U}niversal {T}est {T}reat {T}rials {UT}3 {C}onsortium},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {A}chieving {HIV} epidemic control globally will require new strategies to accelerate reductions in {HIV} incidence and mortality. {U}niversal test and treat ({UTT}) was evaluated in four randomized population-based trials ({BCPP}/{Y}a {T}sie, {HPTN} 071/{P}op{ART}, {SEARCH}, {ANRS} 12249/{T}as{P}) conducted in sub-{S}aharan {A}frica ({SSA}) during expanded antiretroviral treatment ({ART}) eligibility by {W}orld {H}ealth {O}rganization guidelines and the {UNAIDS} 90-90-90 campaign. {D}iscussion {T}hese three-year studies were conducted in {B}otswana, {Z}ambia, {U}ganda, {K}enya and {S}outh {A}frica in settings with baseline {HIV} prevalence from 4% to 30%. {K}ey observations across studies were: (1) {U}niversal testing (implemented via a variety of home and community-based testing approaches) achieved >90% coverage in all studies. (2) {W}hen coupled with robust linkage to {HIV} care, rapid {ART} start and patient-centred care, {UTT} achieved among the highest reported population levels of viral suppression in {SSA}. {S}ignificant gains in population-level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub-populations and were lower among youth. (3) {UTT} resulted in marked reductions in community {HIV} incidence when universal testing and robust linkage were present. {H}owever, {HIV} elimination targets were not reached. {I}n {BCPP} and {HPTN} 071, annualized {HIV} incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). {I}n {SEARCH} (where both arms had universal testing), incidence declined 32% over three years. (4) {UTT} reduced {HIV} associated mortality by 23% in the intervention versus control communities in {SEARCH}, a study in which mortality was comprehensively measured. {C}onclusions {T}hese trials provide strong evidence that {UTT} inclusive of universal testing increases population-level viral suppression and decreases {HIV} incidence and mortality faster than the status quo in {SSA} and should be adapted at a sub-country level as a public health strategy. {H}owever, more is needed, including integration of new prevention interventions into {UTT}, in order to reach {UNAIDS} {HIV} elimination targets.},
  keywords = {{HIV} testing ; antiretroviral therapy ; {HIV} elimination ; {HIV} care continuum ; {HIV} prevention ; {HIV} care continuum ; public health ; universal access ; {BOTSWANA} ; {ZAMBIE} ; {OUGANDA} ; {KENYA} ; {AFRIQUE} {DU} {SUD} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{J}ournal of the {I}nternational {AIDS} {S}ociety},
  volume = {23},
  numero = {2},
  pages = {e25455 [7 ]},
  year = {2020},
  DOI = {10.1002/jia2.25455},
  URL = {https://www.documentation.ird.fr/hor/fdi:010078031},
}