Countrywide HIV Testing and Treatment Intervention: Initial Results of the Zambian PopART Trial

Summary and Comment |
May 18, 2017

Countrywide HIV Testing and Treatment Intervention: Initial Results of the Zambian PopART Trial

  1. Keith Henry, MD

When community care providers used home-based HIV testing and related services, 83% of participating adults knew their HIV status, of whom approximately 74% were receiving ART after 12 months.

  1. Keith Henry, MD

The ambitious WHO 2020 HIV/AIDS goals aim for 90% of HIV+ persons to know their HIV status, 90% of HIV+ persons to be receiving antiretroviral therapy (ART), and 90% of ART recipients to achieve durable viral suppression. The HPTN 071 (PopART) trial assesses the effectiveness of a universal testing and treatment intervention on HIV incidence in urban communities in South Africa and Zambia. In the targeted regions, community health workers (CHWs) conduct annual home-based HIV testing and provide linkage and retention-in-care services. The current report describes progress toward the first two 2020 WHO goals for four regions in Zambia after 1 year (HIV suppression rates not included in this analysis).

From December 2013 to June 2015, 80% of consenting men and 85% of consenting women (n=45,399 and 55,703, respectively) knew their HIV status after the CHW visit. The estimated proportion of all HIV+ persons who knew their status increased from 52% to 78% for men and from 56% to 87% for women. The estimated number of known HIV+ persons on ART increased (from 54% to 74% for men and from 53% to 73% for women). The estimated proportion of all HIV+ persons (with known or unknown status) on ART increased from 44% to 61% (WHO 2020 target, 81%). The authors note that the uptake of home-based testing by lay CHWs was high, although many younger men could not be contacted during routine visits. Linkage to care and initiation of ART were slower than expected, particularly among young people.

Comment

These data represent the initial results of an ambitious effort to implement a test-and-treat strategy in a resource-limited country with a large HIV burden. As an editorialist states, the suboptimal linkage-to-care rates raise concern that forecasts of the effectiveness of the test-and-treat strategy in ending the HIV epidemic may be overly optimistic.

Editor Disclosures at Time of Publication

  • Disclosures for Keith Henry, MD at time of publication Grant / Research support Gilead Sciences; GlaxoSmithKline; ViiV Healthcare; Janssen; Merck Editorial boards Journal of AIDS

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