Abstract Body

Background In 2014 UNAIDS set aspirational global targets for ART coverage for people living with HIV. Many countries currently fall below this target. HPTN 071 (PopART), a community randomised trial in Zambia and South Africa (SA), tests the impact on HIV incidence of a household-based combination HIV prevention approach provided by community-HIV-care-providers (CHiPs). CHiPs deliver universal testing; and for HIV-positive (HIV+) individuals support linkage to, and retention in, HIV care. ART is delivered through routine health care services. We present ART coverage after Round 1 of the intervention in 7 trial communities in which ART is offered to all HIV+ adults irrespective of CD4 count.

The first round of intervention was from November 2013 to mid-2015. Among adults who consented to participate, those included in analysis are all who either self-reported they were HIV+ or they were newly diagnosed by CHiPs with a rapid HIV test. Among these adults who are known by CHiPs to be HIV+, our main outcome is the number and percentage on ART by the end of Round 1, among those still resident in the community at the time of the last CHiP follow-up visit. As part of understanding how this outcome was achieved, we used “time to event” methods to estimate the time to start ART after first referral to HIV care by CHiPs.

In Zambia 12,840, and in SA 3,300, adults were known by CHiPs to be HIV+ during Round 1. At the time of the first CHiPs’ visit, in Zambia 6,249 (49%) and in SA 1,712 (52%) reported they were taking ART; 5,108 (40%) and 1,242 (38%) respectively were newly diagnosed with HIV. Among those not taking ART, in Zambia 6,197 and in SA 1,385 were referred to HIV care; from a time to event analysis, by 12 months later 58% and 53% respectively had initiated ART. At the end of Round 1, in Zambia 80% and in SA 83% of all the adults who were known to be HIV+ were still resident in the same area of the community; 1-2% died and others had moved within (~7%) or outside (~10%) the community.  Among those still resident, in Zambia 71% of men and 72% of women, and in SA 58% of men and 69% of women, were taking ART by the end of Round 1.

Delivery of a home-based combination HIV intervention package conferred a substantial increase in population level ART coverage by the end of Round 1. The increase may be ongoing, as more adults link to HIV care, and as health promotion messages of universal treatment become more widely understood and accepted.