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Treat-all strategy and long-term survival among people living with HIV in South Africa: Results after 6 years of observation in the ANRS 12249 treatment as prevention trial

Baisley, Kathy; Orne-Gliemann, Joanna; Larmarange, Joseph; Plazy, Melanie; Collier, Dami; Dreyer, Jaco; Mngomezulu, Thobeka; ... Iwuji, Collins; + view all (2022) Treat-all strategy and long-term survival among people living with HIV in South Africa: Results after 6 years of observation in the ANRS 12249 treatment as prevention trial. HIV Medicine 10.1111/hiv.13263. (In press). Green open access

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Abstract

Objectives: Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits. Methods: The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial. Results: Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85–1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28–0.85, p = 0.01), but not after the trial ended. Conclusions: The ‘treat all’ strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.

Type: Article
Title: Treat-all strategy and long-term survival among people living with HIV in South Africa: Results after 6 years of observation in the ANRS 12249 treatment as prevention trial
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/hiv.13263
Publisher version: https://doi.org/10.1111/hiv.13263
Language: English
Additional information: © 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: HIV; immediate antiretroviral therapy; mortality; South Africa; test and treat
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10145119
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