Communities in southern Africa which received a door-to-door HIV testing intervention and support for linkage to care had substantially lower HIV incidence, the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle was told today.
This clear-cut effect was seen in the communities randomised to receive these interventions and treatment according to national guidelines, but as those guidelines changed to treatment-for-all early on in the life of the trial, the researchers believe it still provides evidence of the efficacy of the universal test and treat approach.
“Taken together with the findings of other studies, our results provide key evidence that the universal test and treat strategy can bring down incidence of new HIV infections, even in settings with severe generalised HIV epidemics,” Professor Richard Hayes of the London School of Hygiene and Tropical Medicine told a press conference.
PopART, also known as HPTN 071, was a large community-randomised trial carried out in Zambia and KwaZulu-Natal, South Africa. The study aimed to measure the impact on HIV incidence of household-based HIV testing and linkage to care by community health workers (lay counsellors) and immediate initiation of antiretroviral treatment delivered through routine health care services.
PopART was an important test of the feasibility of offering testing and treatment at a very large scale, essential for achievement of the 90-90-90 target of 90% diagnosed, 90% of diagnosed people on treatment and 90% of those on treatment virally suppressed. It is the largest HIV prevention trial ever done: around a million people live in the 21 urban communities in Zambia and South Africa where it was conducted.
While there have been several large trials of the ‘test and treat’ approach in African countries in recent years, their results have been mixed. The ANRS 12249 Treatment as Prevention study showed that a massive scale-up of HIV testing was feasible, but linkage to care was slow and there was no benefit in terms of HIV incidence. SEARCH offered HIV testing alongside screening for non-communicable diseases and achieved very high rates of HIV diagnosis and viral suppression, but not an overall effect on HIV incidence. The Botswana Community Prevention Project led to a 30% drop in HIV infections, although this was of borderline statistical significance.