Effect of universal testing and treatment on HIV incidence - HPTN 071 (PopART).
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: A universal testing and treatment strategy is a potential approach to reduce the incidence of human immunodeficiency virus (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 antiretroviral therapy [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% confidence interval [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. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 071 [PopArt] ClinicalTrials.gov number, NCT01900977.).
Date Issued
2019-07-18
Date Acceptance
2019-07-01
Citation
New England Journal of Medicine, 2019, 381 (3), pp.207-218
ISSN
0028-4793
Publisher
Massachusetts Medical Society
Start Page
207
End Page
218
Journal / Book Title
New England Journal of Medicine
Volume
381
Issue
3
Copyright Statement
© 2019 Massachusetts Medical Society. All rights reserved.
Sponsor
National Institute for Health Research
Pepfar, NIAID, NIMH, NIDA, BMGF
Medical Research Council (MRC)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31314965
Grant Number
HPRU-2012-10080
MR/R015600/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
PREVENTION CASCADE
INFECTION
TRIAL
Adolescent
Adult
Anti-Retroviral Agents
Female
HIV Infections
Humans
Incidence
Male
Mass Drug Administration
Mass Screening
Prevalence
South Africa
Viral Load
Young Adult
Zambia
HPTN 071 (PopART) Study Team
Humans
HIV Infections
Anti-Retroviral Agents
Mass Screening
Viral Load
Incidence
Prevalence
Adolescent
Adult
South Africa
Zambia
Female
Male
Young Adult
Mass Drug Administration
General & Internal Medicine
11 Medical and Health Sciences
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-07-18