@article{fdi:010084354, title = {{T}reat-all strategy and long-term survival among people living with {HIV} in {S}outh {A}frica : results after 6 years of observation in the {ANRS} 12249 treatment as prevention trial}, author = {{B}aisley, {K}. and {O}rne-{G}liemann, {J}. and {L}armarange, {J}oseph and {P}lazy, {M}. and {C}ollier, {D}. and {D}reyer, {J}. and {M}ngomezulu, {T}. and {H}erbst, {K}. and {H}anekom, {W}. and {D}abis, {F}. and {S}iedner, {M}. {J}. and {I}wuji, {C}.}, editor = {}, language = {{ENG}}, abstract = {{O}bjectives: {P}opulation-based universal test and treat ({UTT}) trials have shown an impact on population-level virological suppression. {W}e followed the {ANRS} 12249 {T}as{P} trial population for 6 years to determine whether the intervention had longer-term survival benefits. {M}ethods: {T}he {T}as{P} trial was a cluster-randomized trial in {S}outh {A}frica from 2012 to 2016. {A}ll households were offered 6-monthly home-based {HIV} testing. {I}mmediate antiretroviral therapy ({ART}) was offered through trial clinics to all people living with {HIV} ({PLHIV}) in intervention clusters and according to national guidelines in control clusters. {A}fter the trial, individuals attending the trial clinics were transferred to the public {ART} programme. {D}eaths were ascertained through annual demographic surveillance. {R}andom-effects {P}oisson regression was used to estimate the effect of trial arm on mortality among (i) all {PLHIV}; (ii) {PLHIV} aware of their status and not on {ART} at trial entry; and (iii) {PHLIV} who started {ART} during the trial. {R}esults: {M}ortality rates among {PLHIV} were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. {T}here was no evidence that the intervention decreased mortality among all {PLHIV} [adjusted rate ratio (a{RR}) = 1.10, 95% confidence interval ({CI}) = 0.85-1.43, p = 0.46] or among {PLHIV} who were aware of their status but not on {ART}. {A}mong individuals who initiated {ART}, the intervention decreased mortality during the trial (a{RR} = 0.49, 95% {CI} = 0.28-0.85, p = 0.01), but not after the trial ended. {C}onclusions: {T}he 'treat all' strategy reduced mortality among individuals who started {ART} but not among all {PLHIV}. {T}o achieve maximum benefit of immediate {ART}, barriers to {ART} uptake and retention in care need to be addressed.}, keywords = {{HIV} ; immediate antiretroviral therapy ; mortality ; {S}outh {A}frica ; test and ; treat ; {AFRIQUE} {DU} {SUD}}, booktitle = {}, journal = {{HIV} {M}edicine}, volume = {23}, numero = {8}, pages = {922--928}, ISSN = {1464-2662}, year = {2022}, URL = {https://www.documentation.ird.fr/hor/fdi:010084354}, }