M. Plazy1,2, K. El Farouki3,4, C. Iwuji5,6, N. Okesola5, J. Orne-Gliemann1,2, J. Larmarange5,7, M.-L. Newell8, D. Pillay5,9, F. Dabis1,2, R. Dray-Spira3,4, for the ANRS 12249 TasP Study Group
1INSERM U 897 - Centre Inserm Epidémiologie et Biostatistique, Bordeaux, France, 2Université Bordeaux, Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED), Bordeaux, France, 3INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team of Research in Social Epidemiology, Paris, France, 4Sorbonne Université, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Team of Research in Social Epidemiology, Paris, France, 5Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba, South Africa, 6University College London, Department of Infection and Population Health, London, United Kingdom, 7Ceped (UMR 196 Paris Descartes IRD), IRD, Paris, France, 8Faculty of Medicine, University of Southampton, Southampton, United Kingdom, 9Division of Infection & Immunity, University College London, London, United Kingdom
Background: In a Universal Test and Treat (UTT) strategy, entry into care soon after HIV diagnosis is crucial to achieve optimal population-antiretroviral treatment (ART) coverage. We evaluated the rate of, and factors associated with, entry into care following home-based HIV testing in a cluster-randomised trial of the effect of immediate ART on HIV incidence in rural KwaZulu-Natal, South Africa.
Methods: From March 2012 to May 2014, individuals ≥16 years in ten (2 x 5) clusters were offered home-based HIV testing; those ascertained HIV-positive were referred to TasP trial clinics and were offered universal and immediate ART (intervention clusters) or according to national guidelines (control clusters). Entry into care was defined as attending a TasP clinic within three months of referral among adults not actively in HIV care (no visit to local HIV programme within past 13 months). Associated factors were identified separately by sex, using multivariable logistic regression.
Results: Overall, 1,205 adults (72.6% women) not actively in HIV care were referred to a TasP clinic. Of these, 405 (33.6%) attended a TasP clinic within three months (no difference between trial arms): 32.5% of women, 36.7% of men. Participants who ever visited the local HIV programme (n=360) were more likely to enter into care than those who didn’’t (women: adjusted Odd-Ratio (aOR) 1.76, 95% Confidence Interval [1.26-2.45]; men: 2.07 [1.18-3.64]). In women (n=875), those less likely to attend a TasP clinic within three months had completed some secondary school (0.51 [0.33-0.79]) or at least secondary school (0.47 [0.29-0.76]) versus below primary school; were living 1-2 km from a TasP clinic (0.43 [0.30-0.62]) or 2-5 km (0.40 [0.27-0.61]) versus < 1 km; didn’’t know anyone HIV+ within their family (0.60 [0.43-0.81]) and didn’’t agree that it is good to initiate ART as soon as possible if infected (0.47 [0.26-0.85]); among men (n=330), none of the factors examined was significantly associated with entry into care.
Conclusions: Only one-third of HIV-positive adults referred after home-based HIV testing entered into care within three months in this rural South African community with a 30% HIV prevalence. Innovative interventions should be considered to ensure the success of a UTT strategy.
Plazy Mélanie, El Farouki Kamal, Iwuji Collins, Okesola Nonhlanhla, Orne-Gliemann Joanna, Larmarange Joseph, Newell Marie-Louise, Pillay Deenan, Dabis François, Dray-Spira Rosemary and ANRS 12249 TasP Study Group (2015) “Entry into care following universal home-based HIV testing in rural KwaZulu-Natal, South Africa: the ANRS TasP 12249 cluster-randomised trial” (communication orale n°WEAD0103), presented at the 8th IAS Conference on HIV Pathogeneis, Treatment & Prevention, Vancouver.