20th International AIDS Conference - Melbourne, Australia


WEAC0105LB - Oral Abstract

Feasibility and acceptability of an antiretroviral treatment as prevention (TasP) intervention in rural South Africa: results from the ANRS 12249 TasP cluster-randomised trial

Presented by Collins Iwuji (South Africa).

C. Iwuji1, J. Orne-Gliemann2, F. Tanser1, R. Thiébaut2, J. Larmarange3, N. Okesola1, M.-L. Newell4, F. Dabis2

1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa, 2Bordeaux University, Institut de Santé Publique, Epidemiologie et Developpement, Bordeaux, France, 3Centre Population et Développement (CEPED UMR 196 Université Paris Descartes-Ined-IRD), Paris, France, 4University of Southampton, Faculty of Medicine, Faculty of Social and Human Sciences, Southampton, United Kingdom

Background: For treatment as prevention (TasP) to reduce HIV incidence at population-level, a large proportion of adult community members needs to be regularly HIV tested, and when HIV-positive (HIV+) linked to, and retained on, antiretroviral treatment (ART). We investigated the feasibility and acceptability of TasP in rural KwaZulu-Natal
Methods: Three six-monthly rounds of home-based HIV testing were undertaken in 10 (2x5) clusters of ~1,000 adults each (03/12-03/14). Trial participants were offered rapid HIV testing and provided a dried blood spot (DBS). HIV+ participants were referred to the cluster trial clinic. ART eligibility was ascertained based on point-of-care CD4 testing; ART was offered to all HIV+ in intervention and to those ≤350 CD4 in control clusters
Results: Of 12,911 eligible individuals (residents and ≥16 years), 10,008 (78%) were contacted at least once (67% female; median age 32 years [IQR: 22-52]). Uptake rates compared well to the assumptions from the STDSIM model used to estimate the potential impact of the TasP intervention (Table).

Feasibility IndicatorsModel assumptionsObserved [95%CI] (n/N)
HIV rapid test offer to those eligible90%78% [73-82%] (10,008/12,911)
HIV status ascertainment among contacts80%82% [79-85%] (8,248/10,008)
Baseline HIV prevalence (DBS)24% (end-2011)31% [24-37%] (2,857/9,251)
HIV incidence /100 person-years (repeat DBS)2.4/100 PY (2011)2.5/100 PY [1.8-3.5]
Baseline proportion of HIV+ people on ART39% (end-2011)40% [37-42%] (1,189/2,989)
[Feasibility indicators: assumptions/observations]

Of the 3,404 participants HIV-negative at baseline and offered a second test, 87% (95%-CI: 86-89) accepted. Overall 70% of HIV+ (65-74%; 1,797/2,577) were in care within six months post-referral; 49% (44-53%; 587/1,203) of those newly diagnosed; 79% (199/251) and 39% (110/281) ART-naïve at trial entry initiated ART with median CD4 counts of 367 cells/mm3 (IQR 258-550) and 263 cells/mm3 (IQR 189-326) in intervention and control arms, respectively
Conclusions: These process indicators suggest that the home-based HIV testing strategy and TasP intervention as piloted could decrease HIV incidence at population level. Enrolment is thus expanding to an additional 2x6 clusters from May 2014; all 22 clusters will be followed until June 2016 to estimate the population impact of TasP on HIV incidence.

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