Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART)
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Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART)
Published by Pedro CAHN
Updated: 6 November, 2019
BACKGROUND
A universal testing and treatment strategy is a potential approach to reduce the incidence of 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 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% 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.