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Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa

Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa
Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa
Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa.

Methods: Individuals ?16 years were offered HBHCT; those HIV-positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (5 clusters) or according to national guidelines (5 clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm.

Results: Overall, 1,323 HIV-positive adults (72.9% women) not in HIV care were included, of whom 36.9% (n=488) linked to care <3 months of referral (similar by sex). In adjusted analyses (N=1,222), individuals who had never been in HIV care were significantly less likely to link to care than those who had previously been in care (<33% versus >42%, p<0.001). Linkage to care was lower in students (adjusted Odd-Ratio [aOR]=0.47; 95% Confidence Interval [CI] 0.24-0.92) than in employed adults, in adults who completed secondary school (aOR=0.68; CI 0.49-0.96) or at least some secondary school (aOR=0.59; CI 0.41-0.84) versus ? primary school, in those who lived at 1-2 km (aOR=0.58; CI 0.44-0.78) or 2-5km from the nearest TasP clinic (aOR=0.57; CI 0.41-0.77) versus <1km, and in those who were referred to clinic after ?2 contacts (aOR=0.75; CI 0.58-0.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR=1.45; CI 1.12-1.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV-positive (aOR=2.16; CI 1.13-4.10) versus not.

Conclusions: Fewer than 40% of HIV-positive adults never or not currently in care linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal Test and Treat coverage will require innovative interventions to support linkage to HIV care.

Clinical trial number: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.
1758-2652
1-12
Plazy, Melanie
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El Farouki, Kamal
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Iwuji, Collins
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Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Orne-Gliemann, Joanna
ea462175-cb78-41ad-ad83-1e3a01eab3bb
Larmarange, Joseph
8dc0592c-788f-4521-a3cb-4ff6c6aa06a3
Lert, France
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Newell, Marie-Louise
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Dabis, François
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Dray-Spira, Rosemary
2d84550b-a4f6-4068-84e1-943f0cd9dd74
Plazy, Melanie
e758748d-f8a3-4a68-aaf7-e3b64418dd84
El Farouki, Kamal
2a46fbd8-0382-4c68-8264-20d5bdedaed1
Iwuji, Collins
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Okesola, Nonhlanhla
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Orne-Gliemann, Joanna
ea462175-cb78-41ad-ad83-1e3a01eab3bb
Larmarange, Joseph
8dc0592c-788f-4521-a3cb-4ff6c6aa06a3
Lert, France
665403dd-01be-4ed8-a91f-11666e75a6c4
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Dabis, François
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Dray-Spira, Rosemary
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Plazy, Melanie, El Farouki, Kamal, Iwuji, Collins, Okesola, Nonhlanhla, Orne-Gliemann, Joanna, Larmarange, Joseph, Lert, France, Newell, Marie-Louise, Dabis, François and Dray-Spira, Rosemary (2016) Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa. Journal of the International AIDS Society, 19 (20913), 1-12. (doi:10.7448/IAS.19.1.20913). (PMID:27258430)

Record type: Article

Abstract

Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa.

Methods: Individuals ?16 years were offered HBHCT; those HIV-positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (5 clusters) or according to national guidelines (5 clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm.

Results: Overall, 1,323 HIV-positive adults (72.9% women) not in HIV care were included, of whom 36.9% (n=488) linked to care <3 months of referral (similar by sex). In adjusted analyses (N=1,222), individuals who had never been in HIV care were significantly less likely to link to care than those who had previously been in care (<33% versus >42%, p<0.001). Linkage to care was lower in students (adjusted Odd-Ratio [aOR]=0.47; 95% Confidence Interval [CI] 0.24-0.92) than in employed adults, in adults who completed secondary school (aOR=0.68; CI 0.49-0.96) or at least some secondary school (aOR=0.59; CI 0.41-0.84) versus ? primary school, in those who lived at 1-2 km (aOR=0.58; CI 0.44-0.78) or 2-5km from the nearest TasP clinic (aOR=0.57; CI 0.41-0.77) versus <1km, and in those who were referred to clinic after ?2 contacts (aOR=0.75; CI 0.58-0.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR=1.45; CI 1.12-1.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV-positive (aOR=2.16; CI 1.13-4.10) versus not.

Conclusions: Fewer than 40% of HIV-positive adults never or not currently in care linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal Test and Treat coverage will require innovative interventions to support linkage to HIV care.

Clinical trial number: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.

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Accepted/In Press date: 26 April 2016
e-pub ahead of print date: 1 June 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 393814
URI: http://eprints.soton.ac.uk/id/eprint/393814
ISSN: 1758-2652
PURE UUID: 98c82b4e-cefc-45ce-8711-35109e174fbc
ORCID for Marie-Louise Newell: ORCID iD orcid.org/0000-0002-1074-7699

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Date deposited: 06 May 2016 09:03
Last modified: 07 Oct 2020 05:46

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Contributors

Author: Melanie Plazy
Author: Kamal El Farouki
Author: Collins Iwuji
Author: Nonhlanhla Okesola
Author: Joanna Orne-Gliemann
Author: Joseph Larmarange
Author: France Lert
Author: François Dabis
Author: Rosemary Dray-Spira

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