HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.

<h4>Background</h4>In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 90-90-90 targets: that 90% of people living with HIV know their HIV status, that 90% of those who know their HIV-positive status are on antiretroviral therapy (ART), and that 90% of those on treat...

Full description

Bibliographic Details
Main Authors: Sian Floyd, Kwame Shanaube, Blia Yang, Ab Schaap, Sam Griffith, Mwelwa Phiri, David Macleod, Rosa Sloot, Kalpana Sabapathy, Virginia Bond, Peter Bock, Helen Ayles, Sarah Fidler, Richard Hayes, HPTN 071 (PopART) study team
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2020-04-01
Series:PLoS Medicine
Online Access:https://doi.org/10.1371/journal.pmed.1003067
id doaj-9731dcce911846b984dd1339f99fd465
record_format Article
collection DOAJ
language English
format Article
sources DOAJ
author Sian Floyd
Kwame Shanaube
Blia Yang
Ab Schaap
Sam Griffith
Mwelwa Phiri
David Macleod
Rosa Sloot
Kalpana Sabapathy
Virginia Bond
Peter Bock
Helen Ayles
Sarah Fidler
Richard Hayes
HPTN 071 (PopART) study team
spellingShingle Sian Floyd
Kwame Shanaube
Blia Yang
Ab Schaap
Sam Griffith
Mwelwa Phiri
David Macleod
Rosa Sloot
Kalpana Sabapathy
Virginia Bond
Peter Bock
Helen Ayles
Sarah Fidler
Richard Hayes
HPTN 071 (PopART) study team
HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
PLoS Medicine
author_facet Sian Floyd
Kwame Shanaube
Blia Yang
Ab Schaap
Sam Griffith
Mwelwa Phiri
David Macleod
Rosa Sloot
Kalpana Sabapathy
Virginia Bond
Peter Bock
Helen Ayles
Sarah Fidler
Richard Hayes
HPTN 071 (PopART) study team
author_sort Sian Floyd
title HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
title_short HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
title_full HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
title_fullStr HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
title_full_unstemmed HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.
title_sort hiv testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in zambia and south africa: an analysis of findings from the hptn 071 (popart) trial.
publisher Public Library of Science (PLoS)
series PLoS Medicine
issn 1549-1277
1549-1676
publishDate 2020-04-01
description <h4>Background</h4>In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 90-90-90 targets: that 90% of people living with HIV know their HIV status, that 90% of those who know their HIV-positive status are on antiretroviral therapy (ART), and that 90% of those on treatment are virally suppressed. The aim was to reach these targets by 2020. We assessed the feasibility of achieving the first two targets, and the corresponding 81% ART coverage target, as part of the HIV Prevention Trials Network (HPTN) 071 Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (PopART) community-randomized trial.<h4>Methods and findings</h4>The study population was individuals aged ≥15 years living in 14 urban and peri-urban "PopART intervention" communities in Zambia and South Africa (SA), with a total population of approximately 600,000 and approximately 15% adult HIV prevalence. Community HIV care providers (CHiPs) delivered the PopART intervention during 2014-2017. This was a combination HIV prevention package including universal home-based HIV testing, referral of HIV-positive individuals to government HIV clinic services that offered universal ART (Arm A) or ART according to national guidelines (Arm B), and revisits to HIV-positive individuals to support linkage to HIV care and retention on ART. The intervention was delivered in 3 "rounds," each about 15 months long, during which CHiPs visited all households and aimed to contact all individuals aged ≥15 years at least once. In Arm A in Round 3 (R3), 67% (41,332/61,402) of men and 86% (56,345/65,896) of women in Zambia and 56% (17,813/32,095) of men and 71% (24,461/34,514) of women in SA participated in the intervention, among 193,907 residents aged ≥15 years. Following participation, HIV status was known by 90% of men and women in Zambia and by 78% of men and 85% of women in SA. The median time from CHiP referral of HIV-positive individuals to ART initiation was approximately 3 months. By the end of R3, an estimated 95% of HIV-positive women and 85% of HIV-positive men knew their HIV status, and among these individuals, approximately 90% of women and approximately 85% of men were on ART. ART coverage among all HIV-positive individuals was approximately 85% in women and approximately 75% in men, up from about 45% at the start of the study. ART coverage was lowest among men aged 18 to 34 and women aged 15 to 24 years, and among mobile individuals/in-migrants. Findings from Arm B were similar. The main limitations to our study were that estimates of testing and treatment coverage among men relied on considerable extrapolation because, in each round, approximately one-third of men did not participate in the PopART intervention; that our findings are for a service delivery model that was relatively intensive; and that we did not have comparable data from the 7 "standard-of-care" (Arm C) communities.<h4>Conclusions</h4>Our study showed that very high HIV testing and treatment coverage can be achieved through persistent delivery of universal testing, facilitated linkage to HIV care, and universal treatment services. The ART coverage target of 81% was achieved overall, after 4 years of delivery of the PopART intervention, though important gaps remained among men and young people. Our findings are consistent with previously reported findings from southern and east Africa, extending their generalisability to urban settings with high rates of in-migration and mobility and to Zambia and SA.<h4>Trial registration</h4>ClinicalTrials.gov NCT01900977.
url https://doi.org/10.1371/journal.pmed.1003067
work_keys_str_mv AT sianfloyd hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT kwameshanaube hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT bliayang hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT abschaap hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT samgriffith hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT mwelwaphiri hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT davidmacleod hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT rosasloot hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT kalpanasabapathy hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT virginiabond hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT peterbock hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT helenayles hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT sarahfidler hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT richardhayes hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
AT hptn071popartstudyteam hivtestingandtreatmentcoverageachievedafter4yearsacross14urbanandperiurbancommunitiesinzambiaandsouthafricaananalysisoffindingsfromthehptn071poparttrial
_version_ 1714664713767354368
spelling doaj-9731dcce911846b984dd1339f99fd4652021-04-21T18:34:59ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762020-04-01174e100306710.1371/journal.pmed.1003067HIV testing and treatment coverage achieved after 4 years across 14 urban and peri-urban communities in Zambia and South Africa: An analysis of findings from the HPTN 071 (PopART) trial.Sian FloydKwame ShanaubeBlia YangAb SchaapSam GriffithMwelwa PhiriDavid MacleodRosa SlootKalpana SabapathyVirginia BondPeter BockHelen AylesSarah FidlerRichard HayesHPTN 071 (PopART) study team<h4>Background</h4>In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set the 90-90-90 targets: that 90% of people living with HIV know their HIV status, that 90% of those who know their HIV-positive status are on antiretroviral therapy (ART), and that 90% of those on treatment are virally suppressed. The aim was to reach these targets by 2020. We assessed the feasibility of achieving the first two targets, and the corresponding 81% ART coverage target, as part of the HIV Prevention Trials Network (HPTN) 071 Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (PopART) community-randomized trial.<h4>Methods and findings</h4>The study population was individuals aged ≥15 years living in 14 urban and peri-urban "PopART intervention" communities in Zambia and South Africa (SA), with a total population of approximately 600,000 and approximately 15% adult HIV prevalence. Community HIV care providers (CHiPs) delivered the PopART intervention during 2014-2017. This was a combination HIV prevention package including universal home-based HIV testing, referral of HIV-positive individuals to government HIV clinic services that offered universal ART (Arm A) or ART according to national guidelines (Arm B), and revisits to HIV-positive individuals to support linkage to HIV care and retention on ART. The intervention was delivered in 3 "rounds," each about 15 months long, during which CHiPs visited all households and aimed to contact all individuals aged ≥15 years at least once. In Arm A in Round 3 (R3), 67% (41,332/61,402) of men and 86% (56,345/65,896) of women in Zambia and 56% (17,813/32,095) of men and 71% (24,461/34,514) of women in SA participated in the intervention, among 193,907 residents aged ≥15 years. Following participation, HIV status was known by 90% of men and women in Zambia and by 78% of men and 85% of women in SA. The median time from CHiP referral of HIV-positive individuals to ART initiation was approximately 3 months. By the end of R3, an estimated 95% of HIV-positive women and 85% of HIV-positive men knew their HIV status, and among these individuals, approximately 90% of women and approximately 85% of men were on ART. ART coverage among all HIV-positive individuals was approximately 85% in women and approximately 75% in men, up from about 45% at the start of the study. ART coverage was lowest among men aged 18 to 34 and women aged 15 to 24 years, and among mobile individuals/in-migrants. Findings from Arm B were similar. The main limitations to our study were that estimates of testing and treatment coverage among men relied on considerable extrapolation because, in each round, approximately one-third of men did not participate in the PopART intervention; that our findings are for a service delivery model that was relatively intensive; and that we did not have comparable data from the 7 "standard-of-care" (Arm C) communities.<h4>Conclusions</h4>Our study showed that very high HIV testing and treatment coverage can be achieved through persistent delivery of universal testing, facilitated linkage to HIV care, and universal treatment services. The ART coverage target of 81% was achieved overall, after 4 years of delivery of the PopART intervention, though important gaps remained among men and young people. Our findings are consistent with previously reported findings from southern and east Africa, extending their generalisability to urban settings with high rates of in-migration and mobility and to Zambia and SA.<h4>Trial registration</h4>ClinicalTrials.gov NCT01900977.https://doi.org/10.1371/journal.pmed.1003067