@article{iwuji_evaluation_2013, title = {Evaluation of the impact of immediate versus {WHO} recommendations-guided antiretroviral therapy initiation on {HIV} incidence: the {ANRS} 12249 {TasP} ({Treatment} as {Prevention}) trial in {Hlabisa} sub-district, {KwaZulu}-{Natal}, {South} {Africa}: study protocol for a cluster randomised controlled trial}, volume = {14}, issn = {1745-6215}, shorttitle = {Evaluation of the impact of immediate versus {WHO} recommendations-guided antiretroviral therapy initiation on {HIV} incidence}, url = {http://clinicaltrials.gov/ct2/show/NCT01509508?term=anrs+12249&rank=1}, doi = {10.1186/1745-6215-14-230}, abstract = {BACKGROUND: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes. METHODS/DESIGN: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 {\textless}350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters. DISCUSSION: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.}, number = {1}, urldate = {2013-09-05}, journal = {Trials}, author = {Iwuji, Collins C and Orne-Gliemann, Joanna and Tanser, Frank and Boyer, Sylvie and Lessells, Richard J and Lert, France and Imrie, John and Bärnighausen, Till and Rekacewicz, Claire and Bazin, Brigitte and Newell, Marie-Louise and Dabis, François and {ANRS 12249 TasP study group}}, collaborator = {Dabis, François and Newell, Marie-Louise and Iwuji, Collins and Orne-Gliemann, Joanna and Okesola, Nonhlanhla and Imrie, John and Bärnighausen, Till and Bland, Ruth and Lessells, Richard J and Tanser, Frank and de Oliveira, Tulio and Viljoen, Johannes and Newell, Colin and Naidu, Kevi and Lert, France and Dray-Spira, Rosemary and Larmarange, Joseph and Spire, Bruno and Boyer, Sylvie and Calmy, Alexandra and Chaix, Marie-Laure and Karcher, Sophie and Thiébaut, Rodolphe and Freedberg, Ken}, year = {2013}, pages = {230}, }