Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)

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dc.contributor.authorHayes, Richard J.en_ZA
dc.contributor.authorDonnell, Deborahen_ZA
dc.contributor.authorFloyd, Sianen_ZA
dc.contributor.authorMandla, Nomthaen_ZA
dc.contributor.authorBwalya, Justinen_ZA
dc.contributor.authorSabapathy, Kalpanaen_ZA
dc.contributor.authorYang, Bliaen_ZA
dc.contributor.authorPhiri, Mwelwaen_ZA
dc.contributor.authorSchaap, Aben_ZA
dc.contributor.authorEshleman, Susan H.en_ZA
dc.contributor.authorPiwowar-Manning, Estelleen_ZA
dc.contributor.authorKosloff, Barryen_ZA
dc.contributor.authorJames, Aneleten_ZA
dc.contributor.authorSkalland, Timothyen_ZA
dc.contributor.authorWilson, Ethanen_ZA
dc.contributor.authorEmel, Lyndaen_ZA
dc.contributor.authorMacleod, Daviden_ZA
dc.contributor.authorDunbar, Roryen_ZA
dc.contributor.authorSimwinga, Musondaen_ZA
dc.contributor.authorMakola, Nozizween_ZA
dc.contributor.authorBond, Virginiaen_ZA
dc.contributor.authorMoore, Ayanaen_ZA
dc.contributor.authorGriffith, Samen_ZA
dc.contributor.authorSista, Nirupama Deshmaneen_ZA
dc.contributor.authorVermund, Sten H.en_ZA
dc.contributor.authorEl-Sadr, Wafaaen_ZA
dc.contributor.authorBurns, David N.en_ZA
dc.contributor.authorHargreaves, James R.en_ZA
dc.contributor.authorHauck, Katharinaen_ZA
dc.contributor.authorFraser, Christopheen_ZA
dc.contributor.authorShanaube, Kwameen_ZA
dc.contributor.authorBock, Peteren_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorFidler, Sarahen_ZA
dc.date.accessioned2021-10-18T12:05:56Zen_ZA
dc.date.available2021-10-18T12:05:56Zen_ZA
dc.date.issued2019-07en_ZA
dc.descriptionCITATION: Hayes, R. J. et al. 2019. Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART). New England Journal of Medicine, 381(3):207-218. doi:10.1056/NEJMoa1814556en_ZA
dc.descriptionThe original publication is available at https://www.nejm.org/en_ZA
dc.description.abstractBACKGROUND: A universal testing and treatment strategy is a potential approach to reduce the incidence of human immunodeficiency virus (HIV) infection, yet previous trial results are inconsistent. METHODS: In the HPTN 071 (PopART) community-randomized trial conducted from 2013 through 2018, we randomly assigned 21 communities in Zambia and South Africa (total population, approximately 1 million) to group A (combination prevention intervention with universal antiretroviral therapy [ART]), group B (the prevention intervention with ART provided according to local guidelines [universal since 2016]), or group C (standard care). The prevention intervention included home-based HIV testing delivered by community workers, who also supported linkage to HIV care and ART adherence. The primary outcome, HIV incidence between months 12 and 36, was measured in a population cohort of approximately 2000 randomly sampled adults (18 to 44 years of age) per community. Viral suppression (<400 copies of HIV RNA per milliliter) was assessed in all HIV-positive participants at 24 months. RESULTS: The population cohort included 48,301 participants. Baseline HIV prevalence was 21% or 22% in each group. Between months 12 and 36, a total of 553 new HIV infections were observed during 39,702 person-years (1.4 per 100 person-years; women, 1.7; men, 0.8). The adjusted rate ratio for group A as compared with group C was 0.93 (95% confidence interval [CI], 0.74 to 1.18; P=0.51) and for group B as compared with group C was 0.70 (95% CI, 0.55 to 0.88; P=0.006). The percentage of HIV-positive participants with viral suppression at 24 months was 71.9% in group A, 67.5% in group B, and 60.2% in group C. The estimated percentage of HIV-positive adults in the community who were receiving ART at 36 months was 81% in group A and 80% in group B. CONCLUSIONS: A combination prevention intervention with ART provided according to local guidelines resulted in a 30% lower incidence of HIV infection than standard care. The lack of effect with universal ART was unanticipated and not consistent with the data on viral suppression. In this trial setting, universal testing and treatment reduced the population-level incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 071 [PopArt] ClinicalTrials.gov number, NCT01900977. opens in new tab.)en_ZA
dc.description.sponsorshipNational Institute of Allergy and Infectious Diseasesen_ZA
dc.description.urihttps://www.nejm.org/doi/full/10.1056/NEJMoa1814556en_ZA
dc.description.versionPublisher’s versionen_ZA
dc.format.extent12 pagesen_ZA
dc.identifier.citationHayes, R. J. et al. 2019. Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART). New England Journal of Medicine, 381(3):207-218. doi:10.1056/NEJMoa1814556en_ZA
dc.identifier.issn1533-4406 (online)en_ZA
dc.identifier.issn0028-4793 (print)en_ZA
dc.identifier.otherdoi:10.1056/NEJMoa1814556en_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/123242en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherMassachusetts Medical Societyen_ZA
dc.rights.holderMassachusetts Medical Societyen_ZA
dc.subjectHIV infections -- Preventionen_ZA
dc.subjectAntiretroviral agentsen_ZA
dc.subjectClinical trialsen_ZA
dc.subjectDiseases -- Treatmenten_ZA
dc.subjectCommunicable diseasesen_ZA
dc.subjectDiseases -- Testingen_ZA
dc.titleEffect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)en_ZA
dc.typeArticleen_ZA
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