HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa.
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Havlir Diane V, Balzer Laura B, Charlebois Edwin D, Clark Tamara D, Kwarisiima Dalsone, Ayieko James, Kabami Jane, Sang Norton, Liegler Teri, Chamie Gabriel, Camlin Carol S, Jain Vivek, Kadede Kevin, Atukunda Mucunguzi, Ruel Theodore, Shade Starley B, Ssemmondo Emmanuel, Byonanebye Dathan M, Mwangwa Florence, Owaraganise Asiphas, Olilo Winter, Black Douglas, Snyman Katherine, Burger Rachel, Getahun Monica, Achando Jackson, Awuonda Benard, Nakato Hellen, Kironde Joel, Okiror Samuel, Thirumurthy Harsha, Koss Catherine, Brown Lillian, Marquez Carina, Schwab Joshua, Lavoy Geoff, Plenty Albert, Mugoma Wafula Erick, Omanya Patrick, Chen Yea-Hung, Rooney James F, Bacon Melanie, van der Laan Mark, Cohen Craig R, Bukusi Elizabeth, Kamya Moses R, Petersen Maya
Аннотация
METHODS: We randomly assigned 32 rural communities in Uganda and Kenya to baseline HIV and multidisease testing and national guideline-restricted ART (control group) or to baseline testing plus annual testing, eligibility for universal ART, and patient-centered care (intervention group). The primary end point was the cumulative incidence of HIV infection at 3 years. Secondary end points included viral suppression, death, tuberculosis, hypertension control, and the change in the annual incidence of HIV infection (which was evaluated in the intervention group only).
RESULTS: A total of 150,395 persons were included in the analyses. Population-level viral suppression among 15,399 HIV-infected persons was 42% at baseline and was higher in the intervention group than in the control group at 3 years (79% vs. 68%; relative prevalence, 1.15; 95% confidence interval [CI], 1.11 to 1.20). The annual incidence of HIV infection in the intervention group decreased by 32% over 3 years (from 0.43 to 0.31 cases per 100 person-years; relative rate, 0.68; 95% CI, 0.56 to 0.84). However, the 3-year cumulative incidence (704 incident HIV infections) did not differ significantly between the intervention group and the control group (0.77% and 0.81%, respectively; relative risk, 0.95; 95% CI, 0.77 to 1.17). Among HIV-infected persons, the risk of death by year 3 was 3% in the intervention group and 4% in the control group (0.99 vs. 1.29 deaths per 100 person-years; relative risk, 0.77; 95% CI, 0.64 to 0.93). The risk of HIV-associated tuberculosis or death by year 3 among HIV-infected persons was 4% in the intervention group and 5% in the control group (1.19 vs. 1.50 events per 100 person-years; relative risk, 0.79; 95% CI, 0.67 to 0.94). At 3 years, 47% of adults with hypertension in the intervention group and 37% in the control group had hypertension control (relative prevalence, 1.26; 95% CI, 1.15 to 1.39).
CONCLUSIONS: Universal HIV treatment did not result in a significantly lower incidence of HIV infection than standard care, probably owing to the availability of comprehensive baseline HIV testing and the rapid expansion of ART eligibility in the control group. (Funded by the National Institutes of Health and others; SEARCH ClinicalTrials.gov number, NCT01864603.).