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Early ART initiation improves HIV status disclosure and social support in people living with HIV, linked to care within a universal test and treat program in rural South Africa (ANRS 12249 TasP Trial)

Early ART initiation improves HIV status disclosure and social support in people living with HIV, linked to care within a universal test and treat program in rural South Africa (ANRS 12249 TasP Trial)
Early ART initiation improves HIV status disclosure and social support in people living with HIV, linked to care within a universal test and treat program in rural South Africa (ANRS 12249 TasP Trial)

We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm3 at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.

Early antiretroviral treatment, HIV, HIV status disclosure, Social support, South africa, Test and treat
1090-7165
Fiorentino, Marion
828973b6-84d6-4889-9950-216d3f86bd9b
Nishimwe, Marie
491f1dfd-7daa-496c-888c-2aca10e5e376
Protopopescu, Camelia
3285bd04-8f67-4dad-95a9-7f27e398bf73
Iwuji, Collins
9172710f-6d53-4fc4-8948-2db34293c7ed
Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Spire, Bruno
d0ba1ab9-06ec-4434-9676-29f11749707f
Orne-Gliemann, Joanna
ea462175-cb78-41ad-ad83-1e3a01eab3bb
McGrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Pillay, Deenan
9f521228-ca36-4e1b-9093-64b5705b6ece
Dabis, François
90f9de2e-aaba-4392-97d6-18776521b99f
Larmarange, Joseph
8dc0592c-788f-4521-a3cb-4ff6c6aa06a3
Boyer, Sylvie
ac92cdf4-6029-44dd-8a57-11fea71b7077
for the ANRS 12249 TaSP Study Group
Fiorentino, Marion
828973b6-84d6-4889-9950-216d3f86bd9b
Nishimwe, Marie
491f1dfd-7daa-496c-888c-2aca10e5e376
Protopopescu, Camelia
3285bd04-8f67-4dad-95a9-7f27e398bf73
Iwuji, Collins
9172710f-6d53-4fc4-8948-2db34293c7ed
Okesola, Nonhlanhla
0a55eb44-591c-4c9f-85a1-bd9268d845fc
Spire, Bruno
d0ba1ab9-06ec-4434-9676-29f11749707f
Orne-Gliemann, Joanna
ea462175-cb78-41ad-ad83-1e3a01eab3bb
McGrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Pillay, Deenan
9f521228-ca36-4e1b-9093-64b5705b6ece
Dabis, François
90f9de2e-aaba-4392-97d6-18776521b99f
Larmarange, Joseph
8dc0592c-788f-4521-a3cb-4ff6c6aa06a3
Boyer, Sylvie
ac92cdf4-6029-44dd-8a57-11fea71b7077

Fiorentino, Marion, Nishimwe, Marie and Protopopescu, Camelia , for the ANRS 12249 TaSP Study Group (2020) Early ART initiation improves HIV status disclosure and social support in people living with HIV, linked to care within a universal test and treat program in rural South Africa (ANRS 12249 TasP Trial). AIDS and Behavior. (doi:10.1007/s10461-020-03101-y).

Record type: Article

Abstract

We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm3 at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.

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More information

Accepted/In Press date: 11 November 2020
e-pub ahead of print date: 18 November 2020
Keywords: Early antiretroviral treatment, HIV, HIV status disclosure, Social support, South africa, Test and treat

Identifiers

Local EPrints ID: 445417
URI: http://eprints.soton.ac.uk/id/eprint/445417
ISSN: 1090-7165
PURE UUID: 4d94ebd2-7b73-4a73-9c8f-399f3d9a30d4
ORCID for Nuala McGrath: ORCID iD orcid.org/0000-0002-1039-0159

Catalogue record

Date deposited: 08 Dec 2020 17:30
Last modified: 08 Jan 2022 07:40

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Contributors

Author: Marion Fiorentino
Author: Marie Nishimwe
Author: Camelia Protopopescu
Author: Collins Iwuji
Author: Nonhlanhla Okesola
Author: Bruno Spire
Author: Joanna Orne-Gliemann
Author: Nuala McGrath ORCID iD
Author: Deenan Pillay
Author: François Dabis
Author: Joseph Larmarange
Author: Sylvie Boyer
Corporate Author: for the ANRS 12249 TaSP Study Group

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