HIV ascertainment through repeat home-based testing in the context of a Treatment as Prevention trial (ANRS 12249 TasP) in rural South Africa

Authors

Joseph Larmarange^1,2* Joanna Orne-Gliemann^3* Éric Balestre³ Collins Iwuji¹ Nonhlanhla Okesola¹ Marie-Louise Newell⁴ François Dabis³ France Lert⁵ for the TasP ANRS 12249 Study Group

1. Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa.
2. Centre Population et Développement (CEPED UMR 196 Université Paris Descartes Ined IRD), France.
3. INSERM / University of Bordeaux, ISPED, Centre Inserm U897- Épidemiologie-Biostatistique, France.
4. Faculty of Medicine, University of Southampton, United Kingdom.
5. Centre de recherche en Épidémiologie et Santé des Populations (CESP, Inserm Unité 1018), Villejuif, France.

* first co-authors

Abstract

Background

The ANRS 12249 TasP cluster-randomised trial evaluates whether HIV testing of all members of a community, followed by immediate antiretroviral treatment (ART) for infected people, will prevent onward sexual transmission and reduce HIV incidence at population level. Ascertaining the HIV status of a high proportion of the population regularly and repeatedly is key to the success of any universal test and treat strategy, as the first step of the HIV cascade.

Methods

Between March 2012 and March 2014, we implemented three six-monthly rounds of home-based HIV counselling and testing in ten local communities (clusters). At each home visit, individual questionnaires were administered and a rapid HIV test offered to all trial participants. We report early results on rates of HIV ascertainment, defined as undergoing a rapid HIV test or HIV-positive self-report.

Results

Of 12,911 eligible individuals (resident in the trial area and ≥16 years), 10,007 were successfully contacted at least once. At first contact, HIV status was ascertained for 7,628 (76.2% [95% CI: 75.4-77.1]) individuals. At second contact, among the 5,885 individuals contacted a second time, HIV status was ascertained for 2,829 (85.0% [95% CI: 83.7-86.2]) of the 3,328 tested negative at first contact and for 543 (45.7% [95% CI: 42.9-48.6]) of the 1,188 who refused a rapid test at first contact. Overall, HIV ascertainment rate was 89.0% (5,239/5,885 [95% CI: 88.2-89.8]) among trial participants contacted twice.

Conclusions

Repeat home-based HIV testing is acceptable and feasible in this rural area. Socio-demographic characteristics, behaviours, attitudes, household characteristics and experience of HIV infection and ART in the household will be explored for their association with HIV ascertainment uptake. This will inform whether this intervention reaches the individuals at higher risk in a rural South African region.

Reference

Larmarange Joseph, Orne-Gliemann Joanna, Balestre Eric, Iwuji Collins, Okesola Nonhlanhla, Newell Marie-Louise, Dabis François, Lert France and TasP ANRS 12249 Study Group (2014) “HIV ascertainment through repeat home-based testing in the context of a Treatment as Prevention trial (ANRS 12249 TasP) in rural South Africa” (poster P52.05), presented at the HIV Research for Prevention, Cape Town. DOI : 10.1089/aid.2014.5650.abstract.