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Effect of universal testing and treatment on HIV incidence - HPTN 071 (PopART).

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Title: Effect of universal testing and treatment on HIV incidence - HPTN 071 (PopART).
Authors: Hayes, RJ
Donnell, D
Floyd, S
Mandla, N
Bwalya, J
Sabapathy, K
Yang, B
Phiri, M
Schaap, A
Eshleman, SH
Piwowar-Manning, E
Kosloff, B
James, A
Skalland, T
Wilson, E
Emel, L
Macleod, D
Dunbar, R
Simwinga, M
Makola, N
Bond, V
Hoddinott, G
Moore, A
Griffith, S
Deshmane Sista, N
Vermund, SH
El-Sadr, W
Burns, DN
Hargreaves, JR
Hauck, K
Fraser, C
Shanaube, K
Bock, P
Beyers, N
Ayles, H
Fidler, S
HPTN 071 (PopART) Study Team
Item 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.).
Issue Date: 18-Jul-2019
Date of Acceptance: 1-Jul-2019
URI: http://hdl.handle.net/10044/1/72186
DOI: https://dx.doi.org/10.1056/NEJMoa1814556
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/Funder: National Institute for Health Research
Pepfar, NIAID, NIMH, NIDA, BMGF
Medical Research Council (MRC)
Funder's Grant Number: HPRU-2012-10080
MR/R015600/1
Keywords: HPTN 071 (PopART) Study Team
11 Medical and Health Sciences
General & Internal Medicine
Publication Status: Published
Conference Place: United States
Embargo Date: 2020-01-18
Online Publication Date: 2019-07-18
Appears in Collections:Department of Medicine
Epidemiology, Public Health and Primary Care



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