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No effect of test and treat on sexual behaviours at population level in rural South Africa

No effect of test and treat on sexual behaviours at population level in rural South Africa
No effect of test and treat on sexual behaviours at population level in rural South Africa
Context:Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms.Methods:As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.Results:CLS with regular partner varied between 29–51% and 23–46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5–12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24–5.45)].Conclusion:Universal Test and Treat was not associated with increased sexual risk behaviours.
0269-9370
709–722
Rolland, Matthieu
e3429ba5-2774-4ba6-838d-28f456e6a27c
Mcgrath, Nuala
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Tiendrebeogo, Thierry
7d7bea2c-d7c5-4bb3-a176-721030c48e18
Larmarange, Joseph
8dc0592c-788f-4521-a3cb-4ff6c6aa06a3
Pillay, Deenan
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Dabis, Francois
d6d4dcd8-ae75-441d-b409-8730c5c25fc8
Orne-Gliemann, Joanna
2124c323-6911-49d3-9e50-bddb35f521f8
Rolland, Matthieu
e3429ba5-2774-4ba6-838d-28f456e6a27c
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Tiendrebeogo, Thierry
7d7bea2c-d7c5-4bb3-a176-721030c48e18
Larmarange, Joseph
8dc0592c-788f-4521-a3cb-4ff6c6aa06a3
Pillay, Deenan
9b4da6c6-2220-4c60-aaca-f0f1a37c2ca8
Dabis, Francois
d6d4dcd8-ae75-441d-b409-8730c5c25fc8
Orne-Gliemann, Joanna
2124c323-6911-49d3-9e50-bddb35f521f8

Rolland, Matthieu, Mcgrath, Nuala, Tiendrebeogo, Thierry, Larmarange, Joseph, Pillay, Deenan, Dabis, Francois and Orne-Gliemann, Joanna (2019) No effect of test and treat on sexual behaviours at population level in rural South Africa. AIDS, 33 (4), 709–722. (doi:10.1097/QAD.0000000000002104).

Record type: Article

Abstract

Context:Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms.Methods:As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.Results:CLS with regular partner varied between 29–51% and 23–46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5–12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24–5.45)].Conclusion:Universal Test and Treat was not associated with increased sexual risk behaviours.

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Rolland TasP Sexual behaviours paper 2018 10 26 - Accepted Manuscript
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Accepted/In Press date: 25 October 2018
e-pub ahead of print date: 1 March 2019
Published date: 15 March 2019

Identifiers

Local EPrints ID: 426891
URI: http://eprints.soton.ac.uk/id/eprint/426891
ISSN: 0269-9370
PURE UUID: 936da9db-9169-44c6-a143-41772f904e9d
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 14 Dec 2018 17:30
Last modified: 26 Nov 2021 05:12

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Contributors

Author: Matthieu Rolland
Author: Nuala Mcgrath ORCID iD
Author: Thierry Tiendrebeogo
Author: Joseph Larmarange
Author: Deenan Pillay
Author: Francois Dabis
Author: Joanna Orne-Gliemann

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