Abstract Body

In 2014 UNAIDS set aspirational “90-90-90” global targets for knowledge of HIV status and ART coverage among people living with HIV. HPTN071 (PopART) is a 3-arm community randomised trial in 12 communities in Zambia and 9 communities in South Africa (SA), which tests the impact on HIV incidence of a combination HIV prevention approach compared with standard-of-care.  Household-based interventions are provided in 2 trial arms, and include a universal offer of HIV testing and support for linkage to HIV care. ART is delivered through routine health care services; in one intervention trial arm, it is offered to all HIV-positive (HIV+) adults irrespective of CD4 count. We analysed baseline data on community-wide uptake of HIV testing and ART, to quantify the level of service expansion required to reach the 90-90-90 targets.

A randomly-selected cohort (PC) of adults aged 18-44 years was recruited from November 2013 to March 2015 to measure primary and secondary trial outcomes. Consenting participants provided a blood sample for laboratory HIV testing, and the research questionnaire included questions on previous HIV testing, knowledge of HIV status, and uptake of ART.

38,383 adults were enrolled in the PC, ~2000 in each trial community. A total of 23,362 were enrolled before they were offered the household-based interventions, of whom 21,854 had a laboratory HIV test result available by mid-2015 and 21,776 answered questions on prior HIV testing. HIV prevalence was 12% in men (806/6674) and 27% (4048/15102) in women; 69% of men and 88% of women reported previously testing for HIV, with wide variation among communities. In Zambia, among HIV+ men 46% (172/373) reported they were HIV+ and 31% (117/373) that they were on ART; among HIV+ women  55% (970/1760) reported being HIV+ and 36% (636/1760) were on ART. In SA, among HIV+ men 27% (116/433) reported they were HIV+ and 18% (78/433) that they were on ART;  among HIV+ women 48% (1103/2288) reported being HIV+  and 32% (724/2288) were on ART. Knowledge of HIV status and ART uptake varied considerably across communities, and increased with age.

Among HIV+ men around one-third knew their HIV status and one-quarter were on ART, and among HIV+ women around half knew their HIV status and one-third were on ART, across the trial communities. These levels are far below 90-90-90 targets; the HPTN071 trial will determine whether, with household interventions, the targets can be reached.