Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial
Résumé
BACKGROUND: Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. METHODS: We did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially
Domaines
Santé publique et épidémiologie| Origine | Fichiers produits par l'(les) auteur(s) |
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Soumis le : jeudi 1 décembre 2022-11:28:14
Dernière modification le : mercredi 13 novembre 2024-11:16:02
Archivage à long terme le : jeudi 2 mars 2023-18:37:22
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- HAL Id : hal-03161049 , version 1
- DOI : 10.1016/s2352-3018(17)30205-9
- PUBMED : 29199100
Citer
Collins C. Iwuji, Joanna Orne-Gliemann, Joseph Larmarange, Eric Balestre, Rodolphe Thiébaut, et al.. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial. The Lancet HIV, 2018, 5 (3), pp.e116-e125. ⟨10.1016/s2352-3018(17)30205-9⟩. ⟨hal-03161049⟩
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