دورية أكاديمية
Effect of universal testing and treatment on HIV incidence — HPTN 071 (PopART)
| العنوان: | Effect of universal testing and treatment on HIV incidence — HPTN 071 (PopART) |
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| المؤلفون: | Hayes, RJ, Donnell, D, Floyd, S, Mandla, N, Bwalya, J, Sabapathy, K, Yang, B, Phiri, M, Schaap, A, Eshleman, SH, Piwowar-Manning, E, Kosloff, B, James, A, Skalland, T, Wilson, E, Emel, L, Macleod, D, Dunbar, R, Simwinga, M, Makola, N, Bond, V, Hoddinott, G, Moore, A, Griffith, S, Sista, N, Vermund, SH, El-Sadr, W, Burns, DN, Hargreaves, JR, Hauck, K, Fraser, C, Shanaube, K, Bock, P, Beyers, N, Ayles, H, Fidler, S, Team, HPTN 071 (PopART) Study |
| بيانات النشر: | Massachusetts Medical Society |
| سنة النشر: | 2019 |
| المجموعة: | Oxford University Research Archive (ORA) |
| الوصف: | Background A universal testing and treatment strategy is a potential approach to reduce the incidence of human immunodeficiency virus (HIV) infection, yet previous trial results are inconsistent. Methods In the HPTN 071 (PopART) community-randomized trial conducted from 2013 through 2018, we randomly assigned 21 communities in Zambia and South Africa (total population, approximately 1 million) to group A (combination prevention intervention with universal antiretroviral therapy [ART]), group B (the prevention intervention with ART provided according to local guidelines [universal since 2016]), or group C (standard care). The prevention intervention included home-based HIV testing delivered by community workers, who also supported linkage to HIV care and ART adherence. The primary outcome, HIV incidence between months 12 and 36, was measured in a population cohort of approximately 2000 randomly sampled adults (18 to 44 years of age) per community. Viral suppression (<400 copies of HIV RNA per milliliter) was assessed in all HIV-positive participants at 24 months. Results The population cohort included 48,301 participants. Baseline HIV prevalence was 21% or 22% in each group. Between months 12 and 36, a total of 553 new HIV infections were observed during 39,702 person-years (1.4 per 100 person-years; women, 1.7; men, 0.8). The adjusted rate ratio for group A as compared with group C was 0.93 (95% confidence interval [CI], 0.74 to 1.18; P=0.51) and for group B as compared with group C was 0.70 (95% CI, 0.55 to 0.88; P=0.006). The percentage of HIV-positive participants with viral suppression at 24 months was 71.9% in group A, 67.5% in group B, and 60.2% in group C. The estimated percentage of HIV-positive adults in the community who were receiving ART at 36 months was 81% in group A and 80% in group B. Conclusions A combination prevention intervention with ART provided according to local guidelines resulted in a 30% lower incidence of HIV infection than standard care. The lack of effect with universal ART was ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | https://ora.ox.ac.uk/objects/uuid:4abb17bb-2095-4417-b79b-45e5107a230dTest; https://doi.org/10.1056/NEJMoa1814556Test |
| DOI: | 10.1056/NEJMoa1814556 |
| الإتاحة: | https://doi.org/10.1056/NEJMoa1814556Test https://ora.ox.ac.uk/objects/uuid:4abb17bb-2095-4417-b79b-45e5107a230dTest |
| حقوق: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.45C84AEE |
| قاعدة البيانات: | BASE |
| DOI: | 10.1056/NEJMoa1814556 |
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