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- Title
Antiretroviral Drug Detection in a Community-Randomized Trial of Universal HIV Testing and Treatment: HPTN 071 (PopART).
- Authors
Fogel, Jessica M; Zewdie, Kidist; Clarke, William A; Piwowar-Manning, Estelle; Breaud, Autumn; Moore, Ayana; Kosloff, Barry; Shanaube, Kwame; Zyl, Gert van; Scheepers, Michelle; Floyd, Sian; Bock, Peter; Ayles, Helen; Fidler, Sarah; Hayes, Richard; Donnell, Deborah; Eshleman, Susan H; Team, for the HPTN 071 (PopART) Study
- Abstract
Background Antiretroviral therapy (ART) reduces human immunodeficiency virus (HIV) transmission risk. The primary aim of this study was to evaluate ART uptake in a trial in Zambia and South Africa that implemented a community-wide universal testing and treatment package to reduce HIV incidence. Methods Study communities were randomized to 3 arms: A, combination-prevention intervention with universal ART; B, combination-prevention intervention with ART according to local guidelines; and C, standard of care. Samples were collected from people with HIV (PWH) during a survey visit conducted 2 years after study implementation: these samples were tested for 22 antiretroviral (ARV) drugs. Antiretroviral therapy uptake was defined as detection of ≥1 ARV drug. Resistance was evaluated in 612 randomly selected viremic participants. A 2-stage, cluster-based approach was used to assess the impact of the study intervention on ART uptake. Results Antiretroviral drugs were detected in 4419 of 6207 (71%) samples (Arm A, 73%; Arm B, 70%; Arm C, 60%); 4140 (94%) of samples with ARV drugs had viral loads <400 copies/mL. Drug resistance was observed in 237 of 612 (39%) viremic participants (95 of 102 [93%] with ARV drugs; 142 of 510 [28%] without drugs). Antiretroviral therapy uptake was associated with older age, female sex, enrollment year, seroconverter status, and self-reported ART (all P <.001). The adjusted risk ratio for ART uptake was similar for Arm A versus C (1.21; 95% confidence interval [CI],.94–1.54; P =.12) and Arm B versus C (1.14; 95% CI,.89–1.46; P =.26). Conclusions At the 2-year survey, 71% of PWH were on ART and 94% of those participants were virally suppressed. Universal testing and treatment was not significantly associated with increased ART uptake in this cohort.
- Subjects
ZAMBIA; SOUTH Africa; ANTIRETROVIRAL agents; DIAGNOSIS of HIV infections; HIV; VIRAL load; COMMUNITIES
- Publication
Open Forum Infectious Diseases, 2022, Vol 9, Issue 11, p1
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofac576