1. Repositorio institucional de CLACSO
2. Colección de los Centros Asociados
3. Francia
4. Institut de Recherche pour le Développement - IRD - Cosecha

Título :	Treat-all strategy and long-term survival among people living with HIV in South Africa : results after 6 years of observation in the ANRS 12249 treatment as prevention trial
Palabras clave :	HIV;immediate antiretroviral therapy;mortality;South Africa;test and;treat
Descripción :	Objectives: Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits. Methods: The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial. Results: Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85-1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28-0.85, p = 0.01), but not after the trial ended. Conclusions: The 'treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.
URI :	http://biblioteca-repositorio.clacso.edu.ar/handle/CLACSO/169169
Otros identificadores :	https://www.documentation.ird.fr/hor/fdi:010084354 oai:ird.fr:fdi:010084354 Baisley K., Orne-Gliemann J., Larmarange Joseph, Plazy M., Collier D., Dreyer J., Mngomezulu T., Herbst K., Hanekom W., Dabis F., Siedner M. J., Iwuji C.. Treat-all strategy and long-term survival among people living with HIV in South Africa : results after 6 years of observation in the ANRS 12249 treatment as prevention trial. 2022, [Early access], p. [7 p.]
Aparece en las colecciones:	Institut de Recherche pour le Développement - IRD - Cosecha

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