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ART COVERAGE AFTER 2 YEARS OF A UTT INTERVENTION IN ZAMBIA: FINDINGS FROM HPTN071
Sian Floyd1, Mwelwa Phiri2, Ab Schaap2, David Macleod1, Kwame Shanaube2, Sam Griffith3, Nulda Beyers4, Richard Hayes1, Sarah Fidler5, Helen Ayles6
1London Sch of Hygiene and Trop Med, London, UK,2Zambart, Lusaka, Zambia,3FHI 360, Durham, NC, USA,4Desmond Tutu TB Cntr, Western Cape, South Africa,5Imperial Coll London, London, UK,6London Sch of Hygiene and Trop Med, Lusaka, Zambia
The lack of effect of a universal test-and-treat (UTT) intervention on population-level HIV incidence reported by the TasP study emphasized the importance of high ART coverage. HPTN 071(PopART) is a community-randomized trial in 21 urban communities in Zambia and South Africa, testing the impact on HIV incidence of a household-based combination HIV prevention approach provided by community-HIV-care-providers (CHiPs). In 4 Zambian communities, from November 2013 CHiPs have delivered the 'PopART' UTT package in annual 'rounds', during which they (re-)visit all households. CHiPs refer HIV-positive (HIV+) individuals to routine HIV clinic services, with re-visits to support linkage to care. We present data on ART coverage and retention from round 2 (R2) of delivering the intervention.
R2 was from June 2015–September 2016. Included in analysis are adults (≥18 years) who consented to participate, and who self-reported HIV+ or were newly diagnosed HIV+ by the CHiPs ('known HIV+'). Our main outcomes are the percentage on ART by the end of R2 and the percentage retained on ART at the time of consenting to participate in R2, both self-reported. To help understand how the ART coverage outcome was achieved, we used 'time to event' methods to estimate the percentage who initiated ART by 6 months after referral to HIV care.
Among adults resident during R2, 65% (34,538/53,486) of men and 87% (49,648/57,269) of women consented to participate. Of these, 10% (n=3,405) of men and 16% (n=7,995) of women were known HIV+. On the date of consenting to participate in R2, 64% (n=2,196/3,405) of known HIV+ men and 69% (n=5,504/7,995) of known HIV+ women were on ART, increasing with age from 41% overall among 18-24 year olds to 82% among those ≥55 years; 24% of men and 20% of women were newly diagnosed HIV+. Among those who reported ever taking ART, 92% (2,154/2,329) of men and 95% (5,424/5,730) of women were on ART and missed 0 pills in the last 3 days. By the end of R2, among those still resident according to the last CHiP visit, 78% of men and 79% of women were on ART, ranging from 59% among 18-24 year olds to 88% among those ≥55 years. Compared to R1, initiation on ART by 6 months after referral to HIV care increased from 40% to 60%.
By the end of R2, among adults known to be HIV+, the percentage on ART approached 80%, lower among younger than older adults, retention on ART was high, and the time to initiate ART after referral to care was shortened compared with R1.