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.