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Population uptake of HIV testing, treatment, viral suppression, and male circumcision in Botswana: a cluster-randomized trial
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June 2020
Source: Lancet HIV. 7(6):e422-e433
[PDF-2.17 MB]
Details:
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Alternative Title:Lancet HIV
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Personal Author:
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Description:Background
We sought to determine whether a community-based intervention to identify and rapidly treat persons living with HIV (PLWH) and support male circumcision (MC) could increase population levels of HIV diagnosis, treatment, viral suppression, and MC in Botswana.
Methods
The Ya Tsie study was a pair-matched community-randomized trial conducted in 30 communities across Botswana from 2013–2018; 15 communities were randomized to receive HIV prevention and treatment interventions (including enhanced HIV testing, earlier antiretroviral treatment [ART], and strengthened MC services) and 15 received standard-of-care. We enrolled a cohort of residents aged 16–64 years from a random ~20% sample of households to assess baseline uptake of the following outcomes: (1) proportion known to be HIV-positive or tested HIV-negative in the preceding 12 months; (2) proportion of PLWH diagnosed and on ART; (3) proportion of PLWH on ART with viral suppression; and (4) proportion of HIV-negative men circumcised. In six communities all residents not previously enrolled in the longitudinal cohort completed an end-of-study survey to provide study-end coverage estimates. Differences in intervention uptake over time by arm were tested via paired student’s t-test.
Findings
At baseline we enrolled 2,625 (n=805 PLWH; 403/402 in standard-of-care/intervention communities) residents from the six communities also participating in the end-of-study survey. An additional 10,791 (n=2,691 PLWH; 1,338/1,353 in standard-of-care/intervention communities) residents completed an end-of-study survey in these communities. After accounting for baseline differences, at study-end, the proportion of PLWH who were diagnosed was significantly higher in the intervention arm (absolute increase of 9% to 93% [n=1,254 of 1,353]) compared to standard-of-care (absolute increase of 2% to 88% [n=1,184 of 1,338]) (P=0·03). Population levels of ART, viral suppression, and MC increased from baseline in both arms, with greater increases in intervention communities (ART P=0·02; viral suppression P=0·02; MC P=0·03). At study-end, in intervention communities, 1,228 PLWH (91% of n=1,353) were on ART; 1,166 PLWH (88% of n=1,321 with available viral load) were virally suppressed, and 673 HIV-negative men (40% of n=1,673) were circumcised in intervention communities. The study (NCT01965470) has been completed.
Interpretation
It is possible to achieve very high population levels of HIV testing and treatment in a high-prevalence setting. Maintaining these coverage levels over the next decade could substantially reduce HIV transmission and potentially eliminate the epidemic in these areas.
Funding
US President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.
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Pubmed ID:32504575
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Pubmed Central ID:PMC7864245
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