TY - JOUR
T1 - Projected outcomes of universal testing and treatment in a generalised HIV epidemic in Zambia and South Africa (the HPTN 071 [PopART] trial)
T2 - a modelling study
AU - HPTN 071 (PopART) Study Team
AU - Probert, William J.M.
AU - Sauter, Rafael
AU - Pickles, Michael
AU - Cori, Anne
AU - Bell-Mandla, Nomtha F.
AU - Bwalya, Justin
AU - Abeler-Dörner, Lucie
AU - Bock, Peter
AU - Donnell, Deborah J.
AU - Floyd, Sian
AU - Macleod, David
AU - Piwowar-Manning, Estelle
AU - Skalland, Timothy
AU - Shanaube, Kwame
AU - Wilson, Ethan
AU - Yang, Blia
AU - Ayles, Helen
AU - Fidler, Sarah
AU - Hayes, Richard J.
AU - Fraser, Christophe
AU - Hayes, Richard
AU - Beyers, Nulda
AU - El-Sadr, Wafaa
AU - Cohen, Myron
AU - Eshleman, Susan
AU - Agyei, Yaw
AU - Bond, Virginia
AU - Hoddinott, Graeme
AU - Donnell, Deborah
AU - Emel, Lynda
AU - Noble, Heather
AU - Burns, David
AU - Sista, Nirupama
AU - Griffith, Sam
AU - Moore, Ayana
AU - Headen, Tanette
AU - White, Rhonda
AU - Miller, Eric
AU - Hargreaves, James
AU - Hauck, Katharina
AU - Thomas, Ranjeeta
AU - Limbada, Mohammed
AU - Sabapathy, Kalpana
AU - Schaap, Ab
AU - Dunbar, Rory
AU - Simwinga, Musonda
AU - Smith, Peter
AU - Vermund, Sten
AU - Mandla, Nomtha
AU - Makola, Nozizwe
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2022/11
Y1 - 2022/11
N2 - Background: The long-term impact of universal home-based testing and treatment as part of universal testing and treatment (UTT) on HIV incidence is unknown. We made projections using a detailed individual-based model of the effect of the intervention delivered in the HPTN 071 (PopART) cluster-randomised trial. Methods: In this modelling study, we fitted an individual-based model to the HIV epidemic and HIV care cascade in 21 high prevalence communities in Zambia and South Africa that were part of the PopART cluster-randomised trial (intervention period Nov 1, 2013, to Dec 31, 2017). The model represents coverage of home-based testing and counselling by age and sex, delivered as part of the trial, antiretroviral therapy (ART) uptake, and any changes in national guidelines on ART eligibility. In PopART, communities were randomly assigned to one of three arms: arm A received the full PopART intervention for all individuals who tested positive for HIV, arm B received the intervention with ART provided in accordance with national guidelines, and arm C received standard of care. We fitted the model to trial data twice using Approximate Bayesian Computation, once before data unblinding and then again after data unblinding. We compared projections of intervention impact with observed effects, and for four different scenarios of UTT up to Jan 1, 2030 in the study communities. Findings: Compared with standard of care, a 51% (95% credible interval 40–60) reduction in HIV incidence is projected if the trial intervention (arms A and B combined) is continued from 2020 to 2030, over and above a declining trend in HIV incidence under standard of care. Interpretation: A widespread and continued commitment to UTT via home-based testing and counselling can have a substantial effect on HIV incidence in high prevalence communities. Funding: National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.
AB - Background: The long-term impact of universal home-based testing and treatment as part of universal testing and treatment (UTT) on HIV incidence is unknown. We made projections using a detailed individual-based model of the effect of the intervention delivered in the HPTN 071 (PopART) cluster-randomised trial. Methods: In this modelling study, we fitted an individual-based model to the HIV epidemic and HIV care cascade in 21 high prevalence communities in Zambia and South Africa that were part of the PopART cluster-randomised trial (intervention period Nov 1, 2013, to Dec 31, 2017). The model represents coverage of home-based testing and counselling by age and sex, delivered as part of the trial, antiretroviral therapy (ART) uptake, and any changes in national guidelines on ART eligibility. In PopART, communities were randomly assigned to one of three arms: arm A received the full PopART intervention for all individuals who tested positive for HIV, arm B received the intervention with ART provided in accordance with national guidelines, and arm C received standard of care. We fitted the model to trial data twice using Approximate Bayesian Computation, once before data unblinding and then again after data unblinding. We compared projections of intervention impact with observed effects, and for four different scenarios of UTT up to Jan 1, 2030 in the study communities. Findings: Compared with standard of care, a 51% (95% credible interval 40–60) reduction in HIV incidence is projected if the trial intervention (arms A and B combined) is continued from 2020 to 2030, over and above a declining trend in HIV incidence under standard of care. Interpretation: A widespread and continued commitment to UTT via home-based testing and counselling can have a substantial effect on HIV incidence in high prevalence communities. Funding: National Institute of Allergy and Infectious Diseases, US President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation, National Institute on Drug Abuse, and National Institute of Mental Health.
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U2 - 10.1016/S2352-3018(22)00259-4
DO - 10.1016/S2352-3018(22)00259-4
M3 - Article
C2 - 36332654
AN - SCOPUS:85140998757
SN - 2352-3018
VL - 9
SP - e771-e780
JO - The Lancet HIV
JF - The Lancet HIV
IS - 11
ER -
