%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture non répertoriées par l'AERES
%A Baisley, K.
%A Orne-Gliemann, J.
%A Larmarange, Joseph
%A Plazy, M.
%A Collier, D.
%A Dreyer, J.
%A Mngomezulu, T.
%A Herbst, K.
%A Hanekom, W.
%A Dabis, F.
%A Siedner, M.J.
%A Iwuji, C.
%T Early HIV treatment and survival over six years of observation in the ANRS 12249 treatment as prevention trial
%D 2022
%L fdi:010087012
%G ENG
%J HIV Medicine
%@ 1464-2662
%K AFRIQUE DU SUD
%N 8
%P 922-928
%R 10.1111/hiv.13263
%U https://www.documentation.ird.fr/hor/fdi:010087012
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2023-07/010087012.pdf
%V 23
%W Horizon (IRD)
%X Objectives : Population- based universal test and treat (UTT) trials have shown an impact on population- level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer- term survival benefits. Methods: The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6- monthly home- based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to na-tional guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random- effects Poisson 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. Results: Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person- years in the control and intervention arms, respectively. There was no evidence hat the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 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. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28- 0.85, p = 0.01), but not after the trial ended. Conclusions: The 'treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immedi-ate ART, barriers to ART uptake and retention in care need to be addressed.
%$ 052MALTRA03 ; 050MEDECI ; 108DEMOG1 ; 106PROSO