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1. A mixed methods process evaluation: understanding the implementation and delivery of HIV prevention services integrated within sexual reproductive health (SRH) with or without peer support amongst adolescents and young adults in rural KwaZulu-Natal, South Africa

Author

Zuma, Thembelihle, Busang, Jacob, Hlongwane, Sphesihle, Chidumwa, Glory, Gumede, Dumsani, Luthuli, Manono, Dreyer, Jaco, Herbst, Carina, Okesola, Nonhlanhla, Chimbindi, Natsayi, McGrath, Nuala, Sherr, Lorraine, Seeley, Janet, and Shahmanesh, Maryam

Published
2024
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2. Thetha Nami ngithethe nawe (Let’s Talk): a stepped-wedge cluster randomised trial of social mobilisation by peer navigators into community-based sexual health and HIV care, including pre-exposure prophylaxis (PrEP), to reduce sexually transmissible HIV amongst young people in rural KwaZulu-Natal, South Africa

Author

Busang, Jacob, Zuma, Thembelihle, Herbst, Carina, Okesola, Nonhlanhla, Chimbindi, Natsayi, Dreyer, Jaco, Mtshali, Nelisiwe, Smit, Theresa, Ngubane, Samkelisiwe, Hlongwane, Siphesihle, Gumede, Dumsani, Jalazi, Ashley, Mdluli, Simphiweyenkosi, Bird, Kristien, Msane, Sithembile, Danisa, Priscilla, Hanekom, Willem, Lebina, Limakatso, Behuhuma, Ngundu, Hendrickson, Cheryl, Miot, Jacqui, Seeley, Janet, Harling, Guy, Jarolimova, Jana, Sherr, Lorraine, Copas, Andrew, Baisley, Kathy, and Shahmanesh, Maryam

Published
2023
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5. Effectiveness of integrating HIV prevention within sexual reproductive health services with or without peer support among adolescents and young adults in rural KwaZulu-Natal, South Africa (Isisekelo Sempilo): 2 × 2 factorial, open-label, randomised controlled trial

Author

Shahmanesh, Maryam, Chimbindi, Natsayi, Busang, Jacob, Chidumwa, Glory, Mthiyani, Nondumiso, Herbst, Carina, Okesola, Nonhlanhla, Dreyer, Jaco, Zuma, Thembelihle, Luthuli, Manono, Gumede, Dumsani, Hlongwane, Siphesihle, Mdluli, Simphiwe, Msane, Sithembile, Smit, Theresa, Molina, Jean-Michel, Khoza, Thandeka, Behuhuma, Ngundu Osee, McGrath, Nuala, Seeley, Janet, Harling, Guy, Sherr, Lorraine, Copas, Andrew, and Baisley, Kathy

Abstract

Approximately 200 000 South Africans acquired HIV in 2021 despite the availability of universal HIV test and treat and pre-exposure prophylaxis (PrEP). The aim of this study was to test the effectiveness of sexual and reproductive health services or peer support, or both, on the uptake of serostatus neutral HIV services or reduction of sexually transmissible HIV.

Published
2024
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6. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Author

Bärnighausen, Till, Herbst, Kobus, Iwuji, Collins, Makowa, Thembisa, Naidu, Kevi, Newell, Marie-Louise, Okesola, Nonhlanhla, de Oliveira, Tulio, Pillay, Deenan, Rochat, Tamsen, Tanser, Frank, Viljoen, Johannes, Zuma, Thembelihle, McGrath, Nuala, Balestre, Eric, Dabis, François, Karcher, Sophie, Orne-Gliemann, Joanna, Plazy, Melanie, Prague, Mélanie, Thiébaut, Rodolphe, Tiendrebeogo, Thierry, Boyer, Sylvie, Donfouet, Hermann, Gosset, Andrea, March, Laura, Protopopescu, Camelia, Spire, Bruno, Calmy, Alexandra, Larmarange, Joseph, Inghels, Maxime, Diallo, Hassimiou, Calvez, Vincent, Derache, Anne, Marcelin, Anne-Geneviève, Dray-Spira, Rosemary, Lert, France, El Farouki, Kamal, Lessells, Richard, Freedberg, Kenneth, Imrie, John, Chaix, Marie-Laure, Newell, Colin, Hontelez, Jan, Bazin, Brigitte, Rekacewicz, Claire, Iwuji, Collins C, Thiebaut, Rodolphe, Dreyer, Jaco, and De Oliveira, Tulio

Published
2018
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7. Virological Outcomes of Second-line Protease Inhibitor–Based Treatment for Human Immunodeficiency Virus Type 1 in a High-Prevalence Rural South African Setting: A Competing-Risks Prospective Cohort Analysis

Author

French National Agency for AIDS and Viral Hepatitis Research (ANRS) 12249 Treatment as Prevention (TasP) Study Group, Collier, Dami, Iwuji, Collins, Derache, Anne, de Oliveira, Tulio, Okesola, Nonhlanhla, Calmy, Alexandra, Dabis, Francois, Pillay, Deenan, and Gupta, Ravindra K.

Published
2017

9. Adaptation and pre-test of a shortened Stepping Stones and Creating Futures intervention focused on HIV for young men in rural South Africa

Author

Gibbs, Andrew, primary, Gumede, Dumsani, additional, Adeagbo, Oluwafemi, additional, Sikweyiya, Yandisa, additional, Chirwa, Esnat, additional, Mkhwanazi, Smanga, additional, Luthuli, Manono, additional, Xulu, Zakhele, additional, Herbst, Carina, additional, Zuma, Thembelihle, additional, Hlongwane, Siphesihle, additional, Okesola, Nonhlanhla, additional, Dreyer, Jaco, additional, Khaula, Sivuyile, additional, Washington, Laura, additional, and Shahmanesh, Maryam, additional

Published
2023
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10. Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial)

Author

Plazy, Mélanie, Diallo, Adama, Hlabisa, Thabile, Okesola, Nonhlanhla, Iwuji, Collins, Herbst, Kobus, Boyer, Sylvie, Lert, France, Mcgrath, Nuala, Pillay, Deenan, Dabis, François, Larmarange, Joseph, Orne-Gliemann, Joanna, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Global Health in the Global South (GHiGS), Institut de Recherche pour le Développement (IRD)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Africa Health Research Institute [Durban/Mtubatuba] (AHRI), University of Sussex, University of Brighton, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, University of Southampton, University College of London [London] (UCL), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), and ANRS, BMGF

Subjects
Multidisciplinary, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

Background Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa. Methods In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012–2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to “re-refer” people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up. Results Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47–2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07–7.48). Conclusions Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.

Published
2023

11. The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa

Author

Mthiyane, Nondumiso, primary, Baisley, Kathy, additional, Chimbindi, Natsayi, additional, Zuma, Thembelihle, additional, Okesola, Nonhlanhla, additional, Dreyer, Jaco, additional, Herbst, Carina, additional, Smit, Theresa, additional, Danaviah, Siva, additional, McGrath, Nuala, additional, Harling, Guy, additional, Sherr, Lorraine, additional, Seeley, Janet, additional, Floyd, Sian, additional, Birdthistle, Isolde, additional, and Shahmanesh, Maryam, additional

Published
2022
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12. Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

Author

Larmarange, Joseph, Diallo, Mamadou H., Mcgrath, Nuala, Iwuji, Collins, Plazy, Mélanie, Thiébaut, Rodolphe, Tanser, Frank, Bärnighausen, Till, Orne?Gliemann, Joanna, Pillay, Deenan, Dabis, François, Barnighausen, Till, Herbst, Kobus, Makowa, Thembisa, Naidu, Kevi, Okesola, Nonhlanhla, Oliveira, Tulio, Rochat, Tamsen, Viljoen, Johannes, Zuma, Thembelihle, Balestre, Eric, Dabis, Francois, Karcher, Sophie, Plazy, Melanie, Prague, Melanie, Thiebaut, Rodolphe, Tiendrebeogo, Thierry, Boyer, Sylvie, Donfouet, Hermann, Gosset, Andrea, March, Laura, Protopopescu, Camelia, Spire, Bruno, Calvez, Vincent, Derache, Anne, Marcelin, Anne?Genevieve, Dray?Spira, Rosemary, Lert, France, Farouki, Kamal El, Chaix, Marie?Laure, Bazin, Brigitte, Rekacewicz, Claire, Imrie, John, Lessells, Richard, Newell, Colin, Newell, Marie?Louise, Calmy, Alexandra, Freedberg, Kenneth, and Hontelez, Jan

Subjects
Time trends (Statistics) -- Analysis, Antiviral agents -- Dosage and administration, Immunosuppression -- Patient outcomes, HIV infection -- Risk factors -- Prevention, Health
Abstract

: Introduction: The universal test‐and‐treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods: The TasP cluster‐randomized trial (2012 to 2016) implemented six‐monthly repeat home‐based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 × 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results: 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions: PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART‐initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90‐90‐90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context‐specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH‐27‐0512‐3974 (South African National Clinical Trials Register)., Introduction Antiretroviral treatment (ART), when taken early has several benefits, both in terms of morbidity and mortality and in terms of reduction in HIV sexual transmission. Mathematical modelling work suggested [...]

Published
2019
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13. The association of exposure to DREAMS on sexually acquiring or transmitting HIV amongst adolescent girls and young women living in rural South Africa: a cohort study

Author

Mthiyane, Nondumiso, Baisley, Kathy, Chimbindi, Natsayi, Zuma, Thembelihle, Okesola, Nonhlanhla, Dreyer, Jaco, Herbst, Carina, Smit, Theresa, Danaviah, Siva, Mcgrath, Nuala, Harling, Guy, Sherr, Lorraine, Seeley, Janet, Floyd, Sian, Birdthistle, Isolde, and Shahmanesh, Maryam

Abstract

Background: We investigate how the risk of sexually acquiring or transmitting HIV in adolescent girls and young women (AGYW) changed following the real-world implementation of DREAMS (Determined, Resilient, Empowered, AIDS free, Mentored and Safe) combination HIV prevention. Methods: We recruited a randomly selected population-based cohort of AGYW aged 13 to 22 years (at baseline) living in rural KwaZulu-Natal whom we interviewed annually (2017 to 2019). We measured exposure to DREAMS as self-reported receipt of an invitation to participate and/or participation in DREAMS activities. HIV status was ascertained through blood tests on Dried Blood Spot. We used multivariable regression to assess the association between exposure to DREAMS and risk of acquiring HIV (incident HIV) or having transmissible HIV (being HIV positive with a detectable HIV viral load of >50 copies per millilitre) on the last available DBS. We adjusted for socio-demographic, sexual relationship and migration. Results: A total of 2184 (86.4%) of those eligible agreed to participate and 2016 (92.3%) participants provided data for at least one follow-up time-point. 1030 (54%) were exposed to DREAMS; HIV incidence was 2.2/100 person-years (95% Confidence Interval [CI]: 1.66 to 2.86). There was no evidence that HIV incidence was lower in those exposed to DREAMS: adjusted rate ratio (aRR) 0.83 (95% CI: 0.46 to 1.52). HIV viral load was detectable for 169 (8.9%) respondents one to two years following enrolment; there was no evidence this was lower in those exposed to DREAMS with an adjusted risk difference, compared to those not exposed to DREAMS, of 0.99% [95% CI: -1.52 to 3.82]. Participants who lived in peri-urban/urban setting were more likely to have incident HIV and transmissible HIV. Detectable HIV viral load was also associated with older age and ever having sex. Findings did not differ substantively by respondent age group. Conclusions: DREAMS exposure was not associated with reductions in risk of sexually acquiring or transmitting HIV among a representative cohort of AGYW in rural South Africa.

Published
2022

14. Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis

Author

Adeagbo, Oluwafemi Atanda, primary, Seeley, Janet, additional, Gumede, Dumsani, additional, Xulu, Sibongiseni, additional, Dlamini, Nondumiso, additional, Luthuli, Manono, additional, Dreyer, Jaco, additional, Herbst, Carina, additional, Cowan, F, additional, Chimbindi, Natsayi, additional, Hatzold, Karin, additional, Okesola, Nonhlanhla, additional, Johnson, Cheryl, additional, Harling, Guy, additional, Subedar, Hasina, additional, Sherr, Lorraine, additional, McGrath, Nuala, additional, Corbett, Liz, additional, and Shahmanesh, Maryam, additional

Published
2022
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15. Effect of peer-distributed HIV self-test kits on demand for biomedical HIV prevention in rural KwaZulu-Natal, South Africa: a three-armed cluster-randomised trial comparing social networks versus direct delivery

Author

Shahmanesh, Maryam, primary, Mthiyane, T Nondumiso, additional, Herbsst, Carina, additional, Neuman, Melissa, additional, Adeagbo, Oluwafemi, additional, Mee, Paul, additional, Chimbindi, Natsayi, additional, Smit, Theresa, additional, Okesola, Nonhlanhla, additional, Harling, Guy, additional, McGrath, Nuala, additional, Sherr, Lorraine, additional, Seeley, Janet, additional, Subedar, Hasina, additional, Johnson, Cheryl, additional, Hatzold, Karin, additional, Terris-Prestholt, Fern, additional, Cowan, Frances M, additional, and Corbett, Elizabeth Lucy, additional

Published
2021
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16. Additional file 2 of Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mdluli, Sakhile, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, McGrath, Nuala, Harling, Guy, Sherr, Lorraine, and Seeley, Janet

Subjects
ComputerSystemsOrganization_MISCELLANEOUS
Abstract

Additional file 2 Thetha Nami Participatory Mapping Workshop Tools.

Published
2021
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17. Additional file 5 of Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mdluli, Sakhile, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, McGrath, Nuala, Harling, Guy, Sherr, Lorraine, and Seeley, Janet

Abstract

Additional file 5 Thetha Nami Peer Mentorship Tool.

Published
2021
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18. Additional file 1 of Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mdluli, Sakhile, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, McGrath, Nuala, Harling, Guy, Sherr, Lorraine, and Seeley, Janet

Abstract

Additional file 1 Thetha Nami Peer Navigator Training Programme.

Published
2021
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19. Additional file 3 of Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mdluli, Sakhile, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, McGrath, Nuala, Harling, Guy, Sherr, Lorraine, and Seeley, Janet

Abstract

Additional file 3 Thetha Nami Peer Navigator Monitoring Tool.

Published
2021
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20. Thetha Nami : Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, primary, Okesola, Nonhlanhla, additional, Chimbindi, Natsayi, additional, Zuma, Thembelihle, additional, Mthiyane, Nondumiso, additional, Adeagbo, Oluwafemi, additional, Dreyer, Jaco, additional, Herbst, Carina, additional, Mdl, Sakhile, additional, McGrath, Nuala, additional, Harling, Guy, additional, Sherr, Lorraine, additional, and Seeley, Janet, additional

Published
2021
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21. Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

Author

Shahmanesh, Maryam, primary, Okesola, Nonhlanhla, additional, Chimbindi, Natsayi, additional, Zuma, Thembelihle, additional, Mdl, Sakhile, additional, Mthiyane, Nondumiso, additional, Adeagbo, Oluwafemi, additional, Dreyer, Jaco, additional, Herbst, Carina, additional, McGrath, Nuala, additional, Harling, Guy, additional, Sherr, Lorraine, additional, and Seeley, Janet, additional

Published
2020
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22. Cluster randomised controlled trial to determine the effect of peer delivery HIV self-testing to support linkage to HIV prevention among young women in rural KwaZulu-Natal, South Africa: a study protocol

Author

Adeagbo, Oluwafemi Atanda, primary, Mthiyane, Nondumiso, additional, Herbst, Carina, additional, Mee, Paul, additional, Neuman, Melissa, additional, Dreyer, Jaco, additional, Chimbindi, Natsayi, additional, Smit, Theresa, additional, Okesola, Nonhlanhla, additional, Johnson, Cheryl, additional, Hatzold, Karin, additional, Seeley, Janet, additional, Cowan, Frances, additional, Corbett, Liz, additional, and Shahmanesh, Maryam, additional

Published
2019
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23. Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial

Author

Iwuji, Collins C., Orne-Gliemann, Joanna, Larmarange, Joseph, Okesola, Nonhlanhla, Tanser, Frank, Thiebaut, Rodolphe, Rekacewicz, Claire, Newell, Marie-Louise, and Dabis, Francois

Subjects
HIV infections -- Care and treatment -- Diagnosis, HIV tests -- Usage, Antiretroviral agents -- Research -- Dosage and administration, Wellness programs -- Management, Company business management, Biological sciences
Abstract

Background The 2015 WHO recommendation of antiretroviral therapy (ART) for all immediately following HIV diagnosis is partially based on the anticipated impact on HIV incidence in the surrounding population. We investigated this approach in a cluster-randomised trial in a high HIV prevalence setting in rural KwaZulu-Natal. We present findings from the first phase of the trial and report on uptake of home-based HIV testing, linkage to care, uptake of ART, and community attitudes about ART. Methods and Findings Between 9 March 2012 and 22 May 2014, five clusters in the intervention arm (immediate ART offered to all HIV-positive adults) and five clusters in the control arm (ART offered according to national guidelines, i.e., CD4 count [less than or equal to] 350 cells/[mu]l) contributed to the first phase of the trial. Households were visited every 6 mo. Following informed consent and administration of a study questionnaire, each resident adult ([greater than or equal to]16 y) was asked for a finger-prick blood sample, which was used to estimate HIV prevalence, and offered a rapid HIV test using a serial HIV testing algorithm. All HIV-positive adults were referred to the trial clinic in their cluster. Those not linked to care 3 mo after identification were contacted by a linkage-to-care team. Study procedures were not blinded. In all, 12,894 adults were registered as eligible for participation (5,790 in intervention arm; 7,104 in control arm), of whom 9,927 (77.0%) were contacted at least once during household visits. HIV status was ever ascertained for a total of 8,233/9,927 (82.9%), including 2,569 ascertained as HIV-positive (942 tested HIV-positive and 1,627 reported a known HIV-positive status). Of the 1,177 HIV-positive individuals not previously in care and followed for at least 6 mo in the trial, 559 (47.5%) visited their cluster trial clinic within 6 mo. In the intervention arm, 89% (194/218) initiated ART within 3 mo of their first clinic visit. In the control arm, 42.3% (83/196) had a CD4 count [less than or equal to] 350 cells/[mu]l at first visit, of whom 92.8% initiated ART within 3 mo. Regarding attitudes about ART, 93% (8,802/9,460) of participants agreed with the statement that they would want to start ART as soon as possible if HIV-positive. Estimated baseline HIV prevalence was 30.5% (2,028/6,656) (95% CI 25.0%, 37.0%). HIV prevalence, uptake of home-based HIV testing, linkage to care within 6 mo, and initiation of ART within 3 mo in those with CD4 count [less than or equal to] 350 cells/[mu]l did not differ significantly between the intervention and control clusters. Selection bias related to noncontact could not be entirely excluded. Conclusions Home-based HIV testing was well received in this rural population, although men were less easily contactable at home; immediate ART was acceptable, with good viral suppression and retention. However, only about half of HIV-positive people accessed care within 6 mo of being identified, with nearly two-thirds accessing care by 12 mo. The observed delay in linkage to care would limit the individual and public health ART benefits of universal testing and treatment in this population. Trial registration ClinicalTrials.gov NCT01509508, Author(s): Collins C. Iwuji 1,2,*, Joanna Orne-Gliemann 3,4, Joseph Larmarange 1,5, Nonhlanhla Okesola 1, Frank Tanser 1,6, Rodolphe Thiebaut 3,4, Claire Rekacewicz 7, Marie-Louise Newell 1,8, Francois Dabis 3,4, ANRS [...]

Published
2016
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24. Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa

Author

Plazy, Melanie, Farouki, Kamal El, Iwuji, Collins, Okesola, Nonhlanhla, Orne-Gliemann, Joanna, Larmarange, Joseph, Lert, France, Newell, Marie-Louise, Dabis, Francois, and Dray-Spira, Rosemary

Subjects
Highly active antiretroviral therapy -- Analysis, HIV infections -- Analysis -- Care and treatment, Health
Abstract

Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counseling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. Methods: Individuals [greater than or equal to] 16 years were offered HBHCT; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm. Results: Overall, 1323 HIV-positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n =488) linked to care 42%, p Conclusions: Fewer than 40% of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care. Keywords: HIV/AIDS; home-based HIV counselling and testing; linkage to care; universal test and treat; South Africa., Introduction Initiating antiretroviral treatment (ART) as early as possible after acquiring HIV infection results in better health outcomes, reducing HIV-related morbidity or mortality [1, 2]. Further, decreasing viral load with [...]

Published
2016
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25. J Int AIDS Soc

Author

Larmarange, Joseph, Diallo, Mamadou, McGrath, Nuala, Iwuji, Collins, PLAZY, Mélanie, Thiébaut, Rodolphe, Tanser, Frank, Bärrnighausen, Till, Orne‐Gliemann, Joanna, Pillay, Deenan, Dabis, Francois, Herbst, Kobus, Makowa, Thembisa, Naidu, Kevi, Okesola, Nonhlanhla, Rochat, Tamsen, Viljoen, Johannes, Zuma, Thembelihle, Oliveira, Tulio, Karcher, Sophie, Prague, Mélanie, Tiendrebeogo, Thierry, Boyer, Sylvie, Donfouet, Hermann, Gosset, Andréa, March, Laura, Protopopescu, Camelia, Spire, Bruno, Calvez, Vincent, Derache, Anne, Marcelin, Anne‐Genevieve, Dray‐Spira, Rosemary, Lert, France, El Farouki, Kamal, Chaix, Marie‐Laure, Bazin, Brigitte, Rekacewicz, Claire, Imrie, John, Lessells, Richard, Newell, Colin, Newell, Marie‐Louise, Calmy, Alexandra, Freedberg, Kenneth, Hontelez, Jan, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), London School of Hygiene and Tropical Medicine (LSHTM), Brighton and Sussex Medical School (BSMS), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Africa Health Research Institute [Durban/Mtubatuba] (AHRI), Harvard School of Public Health, University College of London [London] (UCL), Africa Centre for Health and Population Studies, University of KwaZulu-Natal (UKZN)-Medical Research Council of South Africa, Pathogénèse et contrôle des infections chroniques (PCCI), Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Sexual Health Unit, Institut National de la Santé et de la Recherche Médicale (Inserm)-Université de Bordeaux-Institut National de la Santé et de la Recherche Médicale (Inserm)-Université de Bordeaux, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), HIV Unit, Geneva University Hospital, Massachusetts General Hospital [Boston], International Initiative for Impact EvaluationDeutsche Gesellschaft für Internationale Zusammenarbeit. Grant Number: 81151938Wellcome TrustAgence Nationale de Recherches sur le Sida et les Hepatites Virales. Grant Number: 2011‐375Bill and Melinda Gates Foundation, Bordeaux population health (BPH), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Université de Bordeaux (UB), Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales, Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Montpellier (CHU Montpellier )-Université de Montpellier (UM), Epidémiologie, Systèmes d'Information, Modélisation, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Mode de vie, génétique et santé : études intégratives et transgénérationnelles (U1018 (Équipe 9)), Institut Gustave Roussy (IGR)-Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Southampton, Hôpital Universitaire de Genève, Heidelberg University, Public Health, HAL AMU, Administrateur, and Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)

Subjects
Counseling, Male, Rural Population, Impact evaluation, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, South Africa, 0302 clinical medicine, Mass Screening, 030212 general & internal medicine, Viral suppression, 050207 economics, Referral and Consultation, Research Articles, Randomized Controlled Trials as Topic, education.field_of_study, retention in care, 050208 finance, Incidence, 05 social sciences, 3. Good health, SISTM, Infectious Diseases, Female, 0305 other medical science, Research Article, Adult, medicine.medical_specialty, Referral, Anti-HIV Agents, Population, antiretroviral therapy, Context (language use), Population health, IDLIC, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), 0502 economics and business, medicine, Humans, sustained viral suppression, education, Research ethics, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, HIV, medicine.disease, CD4 Lymphocyte Count, Clinical trial, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, Test and treat, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Delivery of Health Care, population health, Demography
Abstract

Background: The universal test-and-treat strategy (UTT) aims to maximize population viral suppression (PVS), i.e. the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed in a community. We investigated whether PVS improved during the course of the ANRS 12249 TasP trial conducted in rural South Africa and investigating UTT impact on HIV incidence. Methods: The TasP cluster-randomized trial (2012-2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2×11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD 4 count in intervention clusters. We measured residency status, HIV status and HIV care status for each participant. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at cluster level. Findings: 8 563 PLHIV were followed. Between cluster opening and January 1, 2016, PVS increased significantly in both arms (intervention: 23·5% to 46·2%, +22·8, p

Published
2019

28. Effet du traitement antirétroviral précoce sur la révélation du statut sérologique du VIH et le soutien social dans un programme de dépistage et traitement universel en Afrique du Sud (essai TasP ANRS 12249)

Author

Nishimwe, Marie, Protopopescu, Camelia, Iwuji, Collins, Okesola, Nonhlanhla, Spire, Bruno, Orne-Gliemann, Joanna, Mcgrath, Nuala, Pillay, Deenan, Dabis, François, Larmarange, Joseph, Boyer, Sylvie, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Africa Health Research Institute [Durban/Mtubatuba] (AHRI), Brighton and Sussex Medical School (BSMS), University College of London [London] (UCL), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Southampton, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), and AFRAVIH

Subjects
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

ObjectifLa révélation du statut VIH et le soutien social sont associés à une meilleure observance au traitement antirétroviral (TARV) et à de bons résultats cliniques. Cette analyse a pour but d’évaluer l’effet de l’initiation précoce du TARV sur la révélation du statut VIH et le soutien social dans un essai de dépistage et traitement universel (UTT) conduit en zone rurale en Afrique du Sud.MéthodesDans cet essai randomisé en clusters (2012-2016), un dépistage universel était proposé à domicile. Les personnes VIH+ orientées vers les cliniques de l’essai pouvaient recevoir le TARV immédiatement dans le bras intervention (I) ou selon les recommandations nationales (CD4≤350 jusqu’au 31/12/2014 puis ≤500) dans le bras contrôle (C). Cette analyse a inclus les patients non traités à la 1re visite (baseline), ayant des CD4>500 et au moins 2 visites de suivi. Un index de révélation (0-5) et un index de soutien social (0-4) ont été estimés à baseline puis tous les 6 mois : un point a été attribué lorsque le patient déclarait avoir révélé son statut VIH à (ou recevoir du soutien social de) au moins un des membres des groupes suivants : partenaire régulier, famille, amis, voisins, autres. Des modèles de Poisson à effets mixtes ont été utilisés pour étudier, après ajustement sur les facteurs individuels, l’effet sur les 2 index : 1) du temps depuis baseline, du bras de randomisation et de leur terme d’interaction statistique ; 2) de l’initiation du TARV (variable dépendante du temps) ; 3) du terme d’interaction statistique entre initiation du TARV et bras.RésultatsSur 3019 patients suivis dans les cliniques de l’essai, 1597 étaient non traités à baseline, dont 473 ayant des CD4>500 et 182 au moins 2 visites (93 dans le bras I et 89 dans le bras C). Le suivi médian [écart interquartile (EIQ)] était de 13,2[7,0-18,5] mois. À 6 mois, 97% étaient sous TARV dans le bras I et 22% dans le bras C. À baseline, la médiane [EIQ] de l’index de révélation était de 2[1-2] versus 1[1-2] dans les bras I et C (p=0,72) et celle de l’index de soutien social de 1[1-2] versus 2[1-3] (p=0,12).Les valeurs des deux index ont augmenté au cours du temps, avec une hausse significativement plus rapide dans le bras I pour le soutien social (ratio du taux d’incidence (RTI) [IC95%]=1,2[1,0 ;1,5] par an versus le bras C) et une évolution similaire entre les bras pour l’index de révélation. L’initiation du TARV était positivement associée aux 2 index (RTI [IC95%]=1,5[1,3 ;1,7]) et 1,3[1,1 ;1,6], respectivement). Pour la révélation du statut, l’initiation du TARV annulait l’effet du bras, alors que pour le soutien social l’effet de l’initiation du TARV était plus important dans le bras I (RTI [IC95%]=1,5[1,1 ;2,0]).ConclusionNos résultats obtenus en milieu rural sud-africain suggèrent que l’initiation précoce du TARV impacterait positivement la révélation du statut VIH et le soutien social. Ces résultats sont encourageants pour les pays qui ont fait le choix de mettre en œuvre des stratégies UTT.

Published
2018

29. Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial).

Author

Fiorentino, Marion, Nishimwe, Marie, Protopopescu, Camelia, Iwuji, Collins, Okesola, Nonhlanhla, Spire, Bruno, Orne-Gliemann, Joanna, McGrath, Nuala, Pillay, Deenan, Dabis, François, Larmarange, Joseph, and Boyer, Sylvie

Subjects
HIV infections, SOCIAL support, CONFIDENCE intervals, RURAL conditions, ANTIRETROVIRAL agents, SELF-disclosure, COMPARATIVE studies, CD4 lymphocyte count, DESCRIPTIVE statistics, EARLY medical intervention, PSYCHOLOGY of HIV-positive persons, POISSON distribution
Abstract

We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm3 at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies. [ABSTRACT FROM AUTHOR]

Published
2021
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30. The impact of early ART initiation on HIV disclosure and social support among people living with HIV and followed within a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial)

Author

Nishimwe, Marie, Protopopescu, Camélia, Iwuji, Collins, Okesola, Nonhlanhla, Spire, Bruno, Orne-Gliemann, Joanna, Mcgrath, Nuala, Pillay, Deenan, Dabis, François, Larmarange, Joseph, Boyer, Sylvie, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Africa Health Research Institute [Durban/Mtubatuba] (AHRI), University College of London [London] (UCL), Brighton and Sussex Medical School (BSMS), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Southampton, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), and Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

AimHIV status disclosure and social support have been associated with increased antiretroviral treatment (ART) adherence and better clinical outcomes. We aimed to investigate the impact of early ART initiation on HIV status disclosure and social support among patients in care within the universal test and treat (UTT) cluster-randomized TasP trial conducted in rural South Africa between 2012 and 2016.Method/IssueFollowing home-based HIV testing, HIV-positive individuals were referred to trial clinics and offered ART regardless of CD4 in intervention arm or according to national guidelines (CD4≤350 cells/mm3 until December 2014, then ≤500 cells/mm3) in control arm. This analysis included patients not ART-treated at baseline (i.e. first clinic visit) and with CD4>500 cells/mm3 who attended at least two clinic visits. HIV disclosure and social support indexes (0-5) were estimated every 6 months: one point was attributed when HIV status was disclosed to - or when the patient reported social support from - at least one member of the following groups: regular partner, family, friends, neighbours, others. We used Poisson mixed effects models, adjusted on individual factors, exploring (i) the impact of time since baseline clinic visit, trial arm and interaction between arm and time; (ii) the impact of ART initiation (time-dependent); and (iii) interaction between arm and ART initiation.Results/CommentsOf 3019 patients entering in care in trial clinics, 1597 were not on ART at baseline, 477 had CD4>500 cells/mm3 and 182 had at least two visits (93 in intervention, 89 in control arm). The 182 participants had a median [interquartile range (IQR)] follow-up duration of 13.2 [7.0-18.5] months. After 6 months, 22% had initiated ART in control arm versus 97% in intervention arm, while after 12 months they were 29% and 98% respectively. At baseline, median [IQR] HIV disclosure index was 2 [1;2] versus 1 [1;2] in intervention and control arms, respectively (p=0.361) and median [IQR] social support index was 1 [0;2] versus 2 [1;3] (p=0.053). Both outcomes significantly improved over time. The social support increased significantly faster in intervention arm (Incidence Rate Ratio (IRR) [95% Confidence Interval (CI)]=1.25 [1.04;1.49] per year for the interaction). HIV disclosure was higher in intervention arm (IRR (95% CI)=1.23 [1.10;1.38]), with a similar increase over time between arms. When introducing ART initiation, treatment appeared positively associated with both outcomes (IRR [95% CI]=1.39 [1.17;1.65] for HIV disclosure and 1.36 [1.13;1.63] for social support). For HIV disclosure, differences in ART initiation between arms explained the higher disclosure observed in intervention arm, the effect of arm not being significant anymore. Initiating ART was also associated to increased social support, and this effect was stronger in intervention arm (IRR [95% CI] =1.51 [1.13;2.01] for the interaction).DiscussionOur findings suggest that, besides clinical benefits, early ART initiation at high CD4 cell count may also positively influence HIV disclosure and social support. For this second outcome, a longer time of follow-up may however be required to observe this benefit. These findings are encouraging for countries that made the choice of implementing UTT strategies.

Published
2017

31. Care trajectories among people living with HIV and followed within a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial)

Author

Gosset, Andréa, Protopopescu, Camelia, Okesola, Nonhlanhla, Spire, Bruno, Larmarange, Joseph, Orne-Gliemann, Joanna, Mcgrath, Nuala, Pillay, Deenan, Dabis, François, Iwuji, Collins, Boyer, Sylvie, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Africa Health Research Institute [Durban/Mtubatuba] (AHRI), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Southampton, University College of London [London] (UCL), Brighton and Sussex Medical School (BSMS), and IAS

Subjects
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

International audience; Background: Retention in care is essential to optimize antiretroviral treatment (ART) impact on viral suppression and ensure the success of the universal test and treat (UTT) strategy. We aimed to identify care trajectories and associated factors among ART-eligible patients within the UTT cluster-randomized TasP trial.Methods: Following home-based HIV testing, HIV-positive individuals were referred to TasP clinics and offered immediate ART (intervention arm) or according to national guidelines (control arm). This analysis included all patients ART-eligible at their first clinic visit ≥18 months before the trial end. Monthly clinical follow-up was offered in TasP clinics. A patient was considered exiting care if ≥3 months late for the last appointment, transferred-out or dead. Care trajectories, assessed over 18 months of follow-up, and their associated factors were identified using a group-based trajectory model (Nagin, 2005, Harvard University Press). Results: Among the 787 ART-eligible patients who attended TasP clinics, four trajectory groups were identified: 70.5% remained in care throughout the entire follow-up period (group 1), 13.6% exited care rapidly (median 4 [IQR 4-6] months after first visit) (group 2), 10.6% exited care latter (11 [9-13] months) (group 3) and 5.2% exited care then returned after 4 [3-9] months (group 4) (Figure 1). The risk of exiting care (groups 2&3) was higher in newly diagnosed patients and those 350 cells/mm3 at first visit, living in high HIV prevalence clusters (>34%) with the lower nurse-patient ratio, and less likely to have initiated ART.Conclusions: Although most patients remained in care over the 18-month period, a significant proportion exited care at different follow-up times. Particular attention should be paid to men, young and newly diagnosed patients, and those with CD4>350 in order to improve retention in care and maximize the effect of UTT strategies.

Published
2017

32. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Author

Iwuji, Collins C, primary, Orne-Gliemann, Joanna, additional, Larmarange, Joseph, additional, Balestre, Eric, additional, Thiebaut, Rodolphe, additional, Tanser, Frank, additional, Okesola, Nonhlanhla, additional, Makowa, Thembisa, additional, Dreyer, Jaco, additional, Herbst, Kobus, additional, McGrath, Nuala, additional, Bärnighausen, Till, additional, Boyer, Sylvie, additional, De Oliveira, Tulio, additional, Rekacewicz, Claire, additional, Bazin, Brigitte, additional, Newell, Marie-Louise, additional, Pillay, Deenan, additional, Dabis, François, additional, Iwuji, Collins, additional, Naidu, Kevi, additional, de Oliveira, Tulio, additional, Rochat, Tamsen, additional, Viljoen, Johannes, additional, Zuma, Thembelihle, additional, Karcher, Sophie, additional, Plazy, Melanie, additional, Prague, Mélanie, additional, Thiébaut, Rodolphe, additional, Tiendrebeogo, Thierry, additional, Donfouet, Hermann, additional, Gosset, Andrea, additional, March, Laura, additional, Protopopescu, Camelia, additional, Spire, Bruno, additional, Calmy, Alexandra, additional, Inghels, Maxime, additional, Diallo, Hassimiou, additional, Calvez, Vincent, additional, Derache, Anne, additional, Marcelin, Anne-Geneviève, additional, Dray-Spira, Rosemary, additional, Lert, France, additional, El Farouki, Kamal, additional, Lessells, Richard, additional, Freedberg, Kenneth, additional, Imrie, John, additional, Chaix, Marie-Laure, additional, Newell, Colin, additional, and Hontelez, Jan, additional

Published
2018
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33. The impact of universal test and treat on HIV incidence in a rural South African population: ANRS 12249 TasP trial, 2012-2016

Author

Iwuji, Collins, Orne-Gliemann, Joanna, Balestre, Eric, Larmarange, Joseph, Thiébaut, Rodolphe, Tanser, Frank, Okesola, Nonhlanhla, Makowa, Thembisa, Dreyer, Jaco, Boyer, Sylvie, Herbst, Kobus, Mcgrath, Nuala, Bärnighausen, Till, de Oliveira, Tulio, Rekacewicz, Claire, Bazin, Brigitte, Newell, Marie-Louise, Pillay, Deenan, Dabis, François, Africa Centre for Health and Population Studies, University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN)-Medical Research Council of South Africa, University College of London [London] (UCL), Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), University of Southampton, and IAS

Subjects
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract

Background: The population impact of universal test and treat (UTT) on HIV transmission has not yet been evaluated.Methods: A cluster-randomized trial was implemented in 2x11 rural communities in KwaZulu-Natal, South Africa. All residents ≥16 years were offered rapid HIV testing and provided dried blood spots (DBS) during 6-monthly home-based survey rounds. HIV-positive participants were referred to cluster-based trial clinics to receive ART regardless of CD4 count (intervention arm) or according to national guidelines (control arm). Standard of care ART was also available in the Department of Health clinics. HIV incidence was estimated on repeat DBS using cluster-adjusted Poisson regression.Results: Between 03/2012 and 04/2016, 13,239 and 14,916 individuals (63% women, median age 30 years) were registered in the intervention and control arms. Contact frequency per round among registered individuals ranged from 64% to 83%, HIV ascertainment from 74% to 85%. Baseline HIV prevalence was 29.4%(95%CI 28.8-30.0), with 7,578 individuals identified as HIV-positive. 1,513(36%) of 4,172 HIV-positive individuals not previously in care linked to trial clinics within 6 months of referral. ART initiation in trial clinics at 3 months was 90.9%(576/634) and 52.3%(332/635) in the intervention and control arms; viral suppression (< 400 copies/mL) 12 months after ART initiation was 94.9%(300/316) and 94.2%(194/206), respectively. Overall ART coverage at entry was 31% and 36% in the intervention and control arms, reaching 41% in both arms by closing date. Repeat DBS tests were available for 13,693 individuals HIV-negative at baseline, yielding 461 seroconversions in 20,833 person-years (PY). HIV incidence was 2.16 per 100 PY (1.88-2.45) in the intervention arm and 2.26 (1.98-2.54) in the control arm (adjusted relative risk: 0.95 [0.82-1.10]). Severe adverse events rates were 3.4%(45/1,323) and 3.5%(57/1,604) in the intervention and control arms. Follow-up will be completed by 06/2016.Conclusions: Our trial shows high acceptance of home-based HIV testing and high levels of viral suppression among individuals on ART. However overall linkage to care remains poor. No reduction in HIV incidence was demonstrated. Several factors are being investigated, including determinants of poor linkage, change in national ART guidelines, migration and geography of sexual networks.

Published
2016

34. Virological Outcomes of Second-line Protease Inhibitor–Based Treatment for Human Immunodeficiency Virus Type 1 in a High-Prevalence Rural South African Setting: A Competing-Risks Prospective Cohort Analysis

Author

Collier, Dami, primary, Iwuji, Collins, additional, Derache, Anne, additional, de Oliveira, Tulio, additional, Okesola, Nonhlanhla, additional, Calmy, Alexandra, additional, Dabis, Francois, additional, Pillay, Deenan, additional, and Gupta, Ravindra K., additional

Published
2017
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36. Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa.

Author

Boyer, Sylvie, Iwuji, Collins, Gosset, Andréa, Protopopescu, Camelia, Okesola, Nonhlanhla, Plazy, Mélanie, Spire, Bruno, Orne-Gliemann, Joanna, McGrath, Nuala, Pillay, Deenan, Dabis, François, and Larmarange, Joseph

Abstract

Prompt uptake of antiretroviral treatment (ART) is essential to ensure the success of universal test and treat (UTT) strategies to prevent HIV transmission in high-prevalence settings. We describe ART initiation rates and associated factors within an ongoing UTT cluster-randomized trial in rural South Africa. HIV-positive individuals were offered immediate ART in the intervention arm vs. national guidelines recommended initiation (CD4≤350 cells/mm3) in the control arm. We used data collected up to July 2015 among the ART-eligible individuals linked to TasP clinics before January 2015. ART initiation rates at one (M1), three (M3) and six months (M6) from baseline visit were described by cluster and CD4 count strata (cells/mm3) and other eligibility criteria: ≤100; 100–200; 200–350; CD4>350 with WHO stage 3/4 or pregnancy; CD4>350 without WHO stage 3/4 or pregnancy. A Cox model accounting for covariate effect changes over time was used to assess factors associated with ART initiation. The 514 participants had a median [interquartile range] follow-up duration of 1.08 [0.69; 2.07] months until ART initiation or last visit. ART initiation rates at M1 varied substantially (36.9% in the group CD4>350 without WHO stage 3/4 or pregnancy, and 55.2–71.8% in the three groups with CD4≤350) but less at M6 (from 85.3% in the first group to 96.1–98.3% in the three other groups). Factors associated with lower ART initiation at M1 were a higher CD4 count and attending clinics with both high patient load and higher cluster HIV prevalence. After M1, having a regular partner was the only factor associated with higher likelihood of ART initiation. These findings suggest good ART uptake within a UTT setting, even among individuals with high CD4 count. However, inadequate staffing and healthcare professional practices could result in prioritizing ART initiation in patients with the lowest CD4 counts. [ABSTRACT FROM AUTHOR]

Published
2016
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37. Additional file 4 of Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mdluli, Sakhile, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, McGrath, Nuala, Harling, Guy, Sherr, Lorraine, and Seeley, Janet

Subjects
3. Good health
Abstract

Additional file 4. Peer Navigator indepth interview topic guide.

38. Additional file 4 of Thetha Nami: participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and youth in rural South Africa

Author

Shahmanesh, Maryam, Okesola, Nonhlanhla, Chimbindi, Natsayi, Zuma, Thembelihle, Mdluli, Sakhile, Mthiyane, Nondumiso, Adeagbo, Oluwafemi, Dreyer, Jaco, Herbst, Carina, McGrath, Nuala, Harling, Guy, Sherr, Lorraine, and Seeley, Janet

Subjects
3. Good health
Abstract

Additional file 4. Peer Navigator indepth interview topic guide.

39. Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

Author

Larmarange, Joseph, Diallo, Mamadou H, McGrath, Nuala, Iwuji, Collins, Plazy, Mélanie, Thiébaut, Rodolphe, Tanser, Frank, Bärnighausen, Till, Orne‐Gliemann, Joanna, Pillay, Deenan, Dabis, François, Barnighausen, Till, Herbst, Kobus, Makowa, Thembisa, Naidu, Kevi, Okesola, Nonhlanhla, Oliveira, Tulio, Rochat, Tamsen, Viljoen, Johannes, Zuma, Thembelihle, Balestre, Eric, Dabis, Francois, Karcher, Sophie, Plazy, Melanie, Prague, Melanie, Thiebaut, Rodolphe, Tiendrebeogo, Thierry, Boyer, Sylvie, Donfouet, Hermann, Gosset, Andrea, March, Laura, Protopopescu, Camelia, Spire, Bruno, Calvez, Vincent, Derache, Anne, Marcelin, Anne‐Genevieve, Dray‐Spira, Rosemary, Lert, France, El Farouki, Kamal, Chaix, Marie‐Laure, Bazin, Brigitte, Rekacewicz, Claire, Imrie, John, Lessells, Richard, Newell, Colin, Newell, Marie‐Louise, Calmy, Alexandra, Freedberg, Kenneth, Hontelez, Jan, Larmarange, Joseph, Diallo, Mamadou H, McGrath, Nuala, Iwuji, Collins, Plazy, Mélanie, Thiébaut, Rodolphe, Tanser, Frank, Bärnighausen, Till, Orne‐Gliemann, Joanna, Pillay, Deenan, Dabis, François, Barnighausen, Till, Herbst, Kobus, Makowa, Thembisa, Naidu, Kevi, Okesola, Nonhlanhla, Oliveira, Tulio, Rochat, Tamsen, Viljoen, Johannes, Zuma, Thembelihle, Balestre, Eric, Dabis, Francois, Karcher, Sophie, Plazy, Melanie, Prague, Melanie, Thiebaut, Rodolphe, Tiendrebeogo, Thierry, Boyer, Sylvie, Donfouet, Hermann, Gosset, Andrea, March, Laura, Protopopescu, Camelia, Spire, Bruno, Calvez, Vincent, Derache, Anne, Marcelin, Anne‐Genevieve, Dray‐Spira, Rosemary, Lert, France, El Farouki, Kamal, Chaix, Marie‐Laure, Bazin, Brigitte, Rekacewicz, Claire, Imrie, John, Lessells, Richard, Newell, Colin, Newell, Marie‐Louise, Calmy, Alexandra, Freedberg, Kenneth, and Hontelez, Jan

Abstract

Introduction The universal test‐and‐treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods The TasP cluster‐randomized trial (2012 to 2016) implemented six‐monthly repeat home‐based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 × 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART‐

40. HIV Ascertainment through Repeat Home-based Testing in the Context of a Treatment as Prevention Trial (ANRS 12249 TasP) in Rural South Africa.

Author

Balestre, Éric, Orne-Gliemann, Joanna, Iwuji, Collins, Okesola, Nonhlanhla, Newell, Marie-Louise, Dabis, François, and Lert, France

Abstract

An abstract of the article "HIV Ascertainment through Repeat Home-based Testing in the Context of a Treatment as Prevention Trial (ANRS 12249 TasP) in Rural South Africa" by Joseph Larmarange and colleagues is presented.

Published
2014
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41. eYoung men's experiences of violence and poverty and the relationship to sexually transmissible HIV: a cross sectional study from rural South Africa.

Author

Gibbs A, Chirwa E, Harling G, Chimbindi N, Dreyer J, Herbst C, Okesola N, Behuhuma O, Mthiyane N, Baisley K, Zuma T, Smit T, McGrath N, Sherr L, Seeley J, and Shahmanesh M

Abstract

Background: Young (ages 18-35 years) men are inadequately engaged in HIV prevention and treatment globally, including in South Africa, increasing the likelihood of them having sexually transmissible HIV (i.e. living with HIV but with high viral loads). We sought to understand how men's experiences of poverty and violence, impacted on transmissible HIV, directly or indirectly via mental health and substance misuse., Setting: Rural communities in northern KwaZulu-Natal, South Africa., Methods: Cross-sectional population-based random selection (September 2018-June 2019), assessing transmissible HIV (living with HIV and viral load ≥400 copies/mL) via dried blood spots, and socio-demographic data. Structural equation models (SEM), assessed direct and indirect pathways from food insecurity and violence experience to transmissible-HIV, with mediators common mental disorders, alcohol use, gender inequitable attitudes and perceptions of life chances., Results: 2,086 young (ages 18-36 years) men and 8.6%(n=178) men had transmissible HIV. In SEM no direct pathways between food insecurity, or violence experience, and transmissible HIV. Poor mental health and alcohol use mediated the relationship between violence experience and food insecurity and transmissible HIV. Life chances also mediated the food insecurity to transmissible HIV pathway., Conclusions: There was a high level of transmissible HIV in a representative sample of young men. The analysis highlights the need to address both the proximate 'drivers' poor mental health and substance misuse, as well as the social contexts shaping these among young men, namely poverty and violence experience. Building holistic interventions that adequately engage these multiple challenges is critical for improving HIV among young men., Competing Interests: Conflict of Interest Statement The authors have no conflict of interests to report.

Published
2024
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42. Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial).

Author

Plazy M, Diallo A, Hlabisa T, Okesola N, Iwuji C, Herbst K, Boyer S, Lert F, McGrath N, Pillay D, Dabis F, Larmarange J, and Orne-Gliemann J

Subjects
Female, Humans, Male, HIV Testing, Referral and Consultation, Rural Population, South Africa epidemiology, Anti-HIV Agents therapeutic use, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections epidemiology
Abstract

Background: Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa., Methods: In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012-2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to "re-refer" people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up., Results: Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47-2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07-7.48)., Conclusions: Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets., Competing Interests: CI has received honoraria for consultancy services and grant funding from Gilead Sciences unrelated to the work described in the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors declare no competing interests., (Copyright: © 2023 Plazy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2023
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