TY - JOUR
T1 - Antiretroviral Drug Detection in a Community-Randomized Trial of Universal HIV Testing and Treatment
T2 - HPTN 071 (PopART)
AU - for the HPTN 071 (PopART) Study Team
AU - Fogel, Jessica M.
AU - Zewdie, Kidist
AU - Clarke, William A.
AU - Piwowar-Manning, Estelle
AU - Breaud, Autumn
AU - Moore, Ayana
AU - Kosloff, Barry
AU - Shanaube, Kwame
AU - Van Zyl, Gert
AU - Scheepers, Michelle
AU - Floyd, Sian
AU - Bock, Peter
AU - Ayles, Helen
AU - Fidler, Sarah
AU - Hayes, Richard
AU - Donnell, Deborah
AU - Eshleman, Susan H.
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - 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.
AB - 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.
KW - ART
KW - Africa
KW - HIV prevention
KW - UTT
KW - antiretroviral drugs
UR - http://www.scopus.com/inward/record.url?scp=85145062632&partnerID=8YFLogxK
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U2 - 10.1093/ofid/ofac576
DO - 10.1093/ofid/ofac576
M3 - Article
C2 - 36447611
AN - SCOPUS:85145062632
SN - 2328-8957
VL - 9
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 11
M1 - ofac576
ER -