Open AccessComparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa
Author(s) -
Perriat Delphine,
Balzer Laura,
Hayes Richard,
Lockman Shahin,
Walsh Fiona,
Ayles Helen,
Floyd Sian,
Havlir Diane,
Kamya Moses,
Lebelonyane Refeletswe,
Mills Lisa A,
Okello Velephi,
Petersen Maya,
Pillay Deenan,
Sabapathy Kalpana,
Wirth Kathleen,
OrneGliemann Joanna,
Dabis François
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25048
Subject(s) - medicine , psychological intervention , context (archaeology) , clinical trial , population , intervention (counseling) , developing country , family medicine , environmental health , clinical study design , gerontology , nursing , economic growth , geography , pathology , archaeology , economics
Design Universal voluntary HIV counselling and testing followed by prompt initiation of antiretroviral therapy ( ART ) for all those diagnosed HIV ‐infected (universal test and treat, UTT ) is now a global health standard. However, its population‐level impact, feasibility and cost remain unknown. Five community‐based trials have been implemented in sub‐Saharan Africa to measure the effects of various UTT strategies at population level: BCPP /YaTsie in Botswana, Max ART in Swaziland, HPTN 071 (Pop ART ) in South Africa and Zambia, SEARCH in Uganda and Kenya and ANRS 12249 TasP in South Africa. This report describes and contrasts the contexts, research methodologies, intervention packages, themes explored, evolution of study designs and interventions related to each of these five UTT trials. Methods We conducted a comparative assessment of the five trials using data extracted from study protocols and collected during baseline studies, with additional input from study investigators. We organized differences and commonalities across the trials in five categories: trial contexts, research designs, intervention packages, trial themes and adaptations. Results All performed in the context of generalized HIV epidemics, the trials highly differ in their social, demographic, economic, political and health systems settings. They share the common aim of assessing the impact of UTT on the HIV epidemic but differ in methodological aspects such as study design and eligibility criteria for trial populations. In addition to universal ART initiation, the trials deliver a wide range of biomedical, behavioural and structural interventions as part of their UTT strategies. The five studies explore common issues, including the uptake rates of the trial services and individual health outcomes. All trials have adapted since their initiation to the evolving political, economic and public health contexts, including adopting the successive national recommendations for ART initiation. Conclusions We found substantial commonalities but also differences between the five UTT trials in their design, conduct and multidisciplinary outputs. As empirical literature on how UTT may improve efficiency and quality of HIV care at population level is still scarce, this article provides a foundation for more collaborative research on UTT and supports evidence‐based decision making for HIV care in country and internationally.