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What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?

INTRODUCTION: Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population‐based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub...

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Autores principales: Havlir, Diane, Lockman, Shahin, Ayles, Helen, Larmarange, Joseph, Chamie, Gabriel, Gaolathe, Tendani, Iwuji, Collins, Fidler, Sarah, Kamya, Moses, Floyd, Sian, Moore, Janet, Hayes, Richard, Petersen, Maya, Dabis, Francois
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038879/
https://www.ncbi.nlm.nih.gov/pubmed/32091179
http://dx.doi.org/10.1002/jia2.25455
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author Havlir, Diane
Lockman, Shahin
Ayles, Helen
Larmarange, Joseph
Chamie, Gabriel
Gaolathe, Tendani
Iwuji, Collins
Fidler, Sarah
Kamya, Moses
Floyd, Sian
Moore, Janet
Hayes, Richard
Petersen, Maya
Dabis, Francois
author_facet Havlir, Diane
Lockman, Shahin
Ayles, Helen
Larmarange, Joseph
Chamie, Gabriel
Gaolathe, Tendani
Iwuji, Collins
Fidler, Sarah
Kamya, Moses
Floyd, Sian
Moore, Janet
Hayes, Richard
Petersen, Maya
Dabis, Francois
author_sort Havlir, Diane
collection PubMed
description INTRODUCTION: Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population‐based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub‐Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90‐90‐90 campaign. DISCUSSION: These three‐year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community‐based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient‐centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population‐level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub‐populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured. CONCLUSIONS: These trials provide strong evidence that UTT inclusive of universal testing increases population‐level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub‐country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.
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spelling pubmed-70388792020-02-26 What do the Universal Test and Treat trials tell us about the path to HIV epidemic control? Havlir, Diane Lockman, Shahin Ayles, Helen Larmarange, Joseph Chamie, Gabriel Gaolathe, Tendani Iwuji, Collins Fidler, Sarah Kamya, Moses Floyd, Sian Moore, Janet Hayes, Richard Petersen, Maya Dabis, Francois J Int AIDS Soc Commentary INTRODUCTION: Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population‐based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub‐Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90‐90‐90 campaign. DISCUSSION: These three‐year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community‐based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient‐centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population‐level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub‐populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured. CONCLUSIONS: These trials provide strong evidence that UTT inclusive of universal testing increases population‐level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub‐country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets. John Wiley and Sons Inc. 2020-02-24 /pmc/articles/PMC7038879/ /pubmed/32091179 http://dx.doi.org/10.1002/jia2.25455 Text en © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Commentary
Havlir, Diane
Lockman, Shahin
Ayles, Helen
Larmarange, Joseph
Chamie, Gabriel
Gaolathe, Tendani
Iwuji, Collins
Fidler, Sarah
Kamya, Moses
Floyd, Sian
Moore, Janet
Hayes, Richard
Petersen, Maya
Dabis, Francois
What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?
title What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?
title_full What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?
title_fullStr What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?
title_full_unstemmed What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?
title_short What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?
title_sort what do the universal test and treat trials tell us about the path to hiv epidemic control?
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038879/
https://www.ncbi.nlm.nih.gov/pubmed/32091179
http://dx.doi.org/10.1002/jia2.25455
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