Towards 90-90 : findings after two years of the HPTN 071 (PopART) cluster-randomized trial of a universal testing-and-treatment intervention in Zambia

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dc.contributor.authorFloyd, Sianen_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorSchaap, Albertusen_ZA
dc.contributor.authorShanaube, Kwameen_ZA
dc.contributor.authorMacLeod, Daviden_ZA
dc.contributor.authorPhiri, Mwelwaen_ZA
dc.contributor.authorGriffith, Samen_ZA
dc.contributor.authorBock, Peteren_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.contributor.authorFidler, Sarahen_ZA
dc.contributor.authorHayes, Richarden_ZA
dc.date.accessioned2020-05-25T14:45:33Z
dc.date.available2020-05-25T14:45:33Z
dc.date.issued2018
dc.descriptionCITATION: Floyd, S., et al. 2018. Towards 90-90 : findings after two years of the HPTN 071 (PopART) cluster-randomized trial of a universal testing-and-treatment intervention in Zambia. PLoS ONE, 13(8):e0197904, doi:10.1371/journal.pone.0197904.
dc.descriptionThe original publication is available at https://journals.plos.org/plosone/
dc.description.abstractBackground: HPTN071(PopART) is a 3-arm community-randomised study in 21 peri-urban/urban communities in Zambia and the Western Cape of South Africa, with high HIV prevalence and high mobility especially among young adults. In Arm A communities, from November 2013 community HIV care providers (CHiPs) have delivered the “PopART” universal-test-and-treat (UTT) package in annual rounds, during which they visit all households and offer HIV testing. CHiPs refer HIV-positive (HIV+) individuals to routine HIV clinic services, where universal ART (irrespective of CD4 count) is offered, with re-visits to support linkage to care. The overall goal is to reduce population-level adult HIV incidence, through achieving high HIV testing and treatment coverage. Methods and findings: The second annual round was June 2015-October 2016. Included in analysis are all individuals aged ≥15 years who consented to participate, with extrapolation to the total population. Our three main outcomes are (1) knowledge of HIV+ status (2) ART coverage, by the end of Round 2 (R2) and compared with the start of R2, and (3) retention on ART on the day of consenting to participate in R2. We used “time-to-event” methods to estimate the median time to start ART after referral to care. CHiPs visited 45,631 households during R2, ~98% of the estimated total across the four communities, and for 94% (43,022/45,631) consent was given for all household members to be listed on the CHiPs’ electronic register; 120,272 individuals aged ≥15 years were listed, among whom 64% of men (37,265/57,901) and 86% (53,516/62,371) of women consented to participate in R2. We estimated there were 6,521 HIV+ men and 10,690 HIV+ women in the total population of visited households; and that ~80% and ~90% of HIV+ men and women respectively knew their HIV+ status by the end of R2, fairly similar across age groups but lower among those who did not participate in Round 1 (R1). Among those who knew their HIV+ status, ~80% of both men and women were on ART by the end of R2, close to 90% among men aged ≥45 and women aged ≥35 years, but lower among younger adults, those who were resident in R1 but did not participate in R1, and those who were newly resident in the area of the community in which they were living in R2. Overall ART coverage was ~65% among HIV+ men and ~75% among HIV+ women, compared with the cumulative 90–90 target of 81%. Among those who reported ever taking ART, 93% of men and 95% of women self-reported they were on ART and missed 0 pills in the last 3 days. The median time to start ART after referral to care was ~6 months in R2, similar across the age range 25–54 years, compared with ~9.5 months in R1. The two main limitations to our findings were that a comparison with control-arm communities cannot be made until the end of the study; and that to extrapolate to the total population, assumptions were required about individuals who were resident, but did not participate, in R2. Conclusions: Overall coverage against the 90–90 targets was high after two years of intervention, but was lower among men, individuals aged 18–34 years, and those who did not participate in R1. Our findings reflect the relative difficulties for CHiPs to contact men at home, compared with women, and that it is challenging to reach high levels of testing and treatment coverage in communities with substantial mobility and in-migration. The shortened time to start ART after referral to care in R2, compared with R1, was likely attributable to multiple factors including an increased focus of the CHiPs on linkage to care; increasing community acceptance and understanding of the CHiPs, and of ART and UTT, with time; increased coordination with the clinics to facilitate linkage; and clinic improvements.en_ZA
dc.description.urihttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197904
dc.description.versionPublisher's version
dc.format.extent22 pages
dc.identifier.citationFloyd, S., et al. 2018. Towards 90-90 : findings after two years of the HPTN 071 (PopART) cluster-randomized trial of a universal testing-and-treatment intervention in Zambia. PLoS ONE, 13(8):e0197904, doi:10.1371/journal.pone.0197904
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0197904
dc.identifier.urihttp://hdl.handle.net/10019.1/108600
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectHIV infections -- Testingen_ZA
dc.subjectAntiretroviral therapy -- Southern Africaen_ZA
dc.subjectPopARTen_ZA
dc.subjectHPTN 071en_ZA
dc.subjectHIV-positive persons -- Care -- Zambia -- South Africaen_ZA
dc.subjectHousehold fluidity -- Southern Africaen_ZA
dc.subjectHIV infections -- Treatmenten_ZA
dc.titleTowards 90-90 : findings after two years of the HPTN 071 (PopART) cluster-randomized trial of a universal testing-and-treatment intervention in Zambiaen_ZA
dc.typeArticleen_ZA
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