Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial

• Published in: PLoS medicine 2016-08, Vol.13 (8), p.e1002107
• Main Authors: Iwuji, Collins C, Orne-Gliemann, Joanna, Larmarange, Joseph, Okesola, Nonhlanhla, Tanser, Frank, Thiebaut, Rodolphe, Rekacewicz, Claire, Newell, Marie-Louise, Dabis, Francois
• Format: Article
• Language: English
• Subjects: Adult; AIDS Serodiagnosis - methods; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Attitude to Health; Attitudes; Biology and Life Sciences; Care and treatment; Clinics; Continuity of Patient Care - organization & administration; Diagnosis; Disease transmission; Dosage and administration; Drug therapy; Female; HIV; HIV infections; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - psychology; HIV tests; Human immunodeficiency virus; Humans; Life Sciences; Male; Management; Medical tests; Medicine and Health Sciences; Mens health; Middle Aged; People and places; Population; Research and Analysis Methods; Rural areas; Rural Population - statistics & numerical data; Santé publique et épidémiologie; Self Care - methods; Sexual Partners; South Africa - epidemiology; Studies; Wellness programs; Young Adult
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1002107

The 2015 WHO recommendation of antiretroviral therapy (ART) for all immediately following HIV diagnosis is partially based on the anticipated impact on HIV incidence in the surrounding population. We investigated this approach in a cluster-randomised trial in a high HIV prevalence setting in rural KwaZulu-Natal. We present findings from the first phase of the trial and report on uptake of home-based HIV testing, linkage to care, uptake of ART, and community attitudes about ART. Between 9 March 2012 and 22 May 2014, five clusters in the intervention arm (immediate ART offered to all HIV-positive adults) and five clusters in the control arm (ART offered according to national guidelines, i.e., CD4 count ≤ 350 cells/μl) contributed to the first phase of the trial. Households were visited every 6 mo. Following informed consent and administration of a study questionnaire, each resident adult (≥16 y) was asked for a finger-prick blood sample, which was used to estimate HIV prevalence, and offered a rapid HIV test using a serial HIV testing algorithm. All HIV-positive adults were referred to the trial clinic in their cluster. Those not linked to care 3 mo after identification were contacted by a linkage-to-care team. Study procedures were not blinded. In all, 12,894 adults were registered as eligible for participation (5,790 in intervention arm; 7,104 in control arm), of whom 9,927 (77.0%) were contacted at least once during household visits. HIV status was ever ascertained for a total of 8,233/9,927 (82.9%), including 2,569 ascertained as HIV-positive (942 tested HIV-positive and 1,627 reported a known HIV-positive status). Of the 1,177 HIV-positive individuals not previously in care and followed for at least 6 mo in the trial, 559 (47.5%) visited their cluster trial clinic within 6 mo. In the intervention arm, 89% (194/218) initiated ART within 3 mo of their first clinic visit. In the control arm, 42.3% (83/196) had a CD4 count ≤ 350 cells/μl at first visit, of whom 92.8% initiated ART within 3 mo. Regarding attitudes about ART, 93% (8,802/9,460) of participants agreed with the statement that they would want to start ART as soon as possible if HIV-positive. Estimated baseline HIV prevalence was 30.5% (2,028/6,656) (95% CI 25.0%, 37.0%). HIV prevalence, uptake of home-based HIV testing, linkage to care within 6 mo, and initiation of ART within 3 mo in those with CD4 count ≤ 350 cells/μl did not differ significantly between the intervention and control clusters. S