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

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.

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dc.creator	Baisley, K.
dc.creator	Orne-Gliemann, J.
dc.creator	/Larmarange, Joseph
dc.creator	Plazy, M.
dc.creator	Collier, D.
dc.creator	Dreyer, J.
dc.creator	Mngomezulu, T.
dc.creator	Herbst, K.
dc.creator	Hanekom, W.
dc.creator	Dabis, F.
dc.creator	Siedner, M. J.
dc.creator	Iwuji, C.
dc.date	2022
dc.date.accessioned	2022-04-27T17:37:56Z
dc.date.available	2022-04-27T17:37:56Z
dc.identifier	https://www.documentation.ird.fr/hor/fdi:010084354
dc.identifier	oai:ird.fr:fdi:010084354
dc.identifier	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.]
dc.identifier.uri	http://biblioteca-repositorio.clacso.edu.ar/handle/CLACSO/169169
dc.description	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.
dc.language	EN
dc.subject	HIV
dc.subject	immediate antiretroviral therapy
dc.subject	mortality
dc.subject	South Africa
dc.subject	test and
dc.subject	treat
dc.title	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
dc.type	text
dc.coverage	AFRIQUE DU SUD