Did home HIV testing and immediate ART work in rural KwaZulu-Natal?
In 10 TasP clusters, 77% of 12,894 adults were contacted and HIV prevalence was 30.5%, but only 47.5% of untreated positives reached clinic care within 6 months.
Source
Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial
Study at a glance
- Design
- RCT — Descriptive first-phase results of the ANRS 12249 TasP cluster-randomised trial (10 clusters; immediate ART vs CD4 ≤350 guideline ART).
- N
- N=12894 · 12,894 registered eligible adults; 9,927 (77.0%) contacted; HIV status ascertained in 8,233.
- Population
- Resident adults ≥16 years in rural KwaZulu-Natal, South Africa (high HIV-prevalence communities).
- Outcome
- Home-based HIV testing uptake, 6-month linkage to trial clinics, 3-month ART initiation, and community ART attitudes.
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Did home HIV testing and immediate ART work in rural KwaZulu-Natal?
These passages occur verbatim in the stored paper text. They support the points listed below; they do not verify every statement in the explanation.
12,894 adults were registered; 9,927 (77.0%) were contacted at least once.
In all, 12,894 adults were registered as eligible for participation (5,790 in intervention arm; 7,104 in control arm), of whom 9,927 (77.0%) were contacted at least once during household visits.
HIV prevalence was 30.5% (2,028/6,656).
Estimated baseline HIV prevalence was 30.5% (2,028/6,656) (95% CI 25.0%, 37.0%).
What they did
Visited households every 6 months (Mar 2012–May 2014), offered rapid HIV tests, referred all positives to cluster clinics, and compared immediate ART versus South African CD4 ≤350 guidelines in five clusters per arm.
What they found
HIV status was ascertained in 82.9% of those contacted. Linkage within 6 months was 47.5% (559/1,177). Immediate-ART initiators started within 3 months in 89% (194/218). 93% said they would want ART as soon as possible if HIV-positive. Men were harder to find at home (53.3% vs 75.2% contact).
The limits
What it doesn't show
This first-phase implementation report cannot yet show whether universal ART cut population HIV incidence; noncontact (especially of men) may bias uptake estimates.
Key terms
- TasP
- Treatment as Prevention: offer ART to HIV-positive people to cut transmission as well as treat disease.
- Home-based HIV testing
- Finger-prick rapid tests offered during 6-monthly household visits to resident adults ≥16 years.
- Linkage to care
- First visit to the cluster trial clinic after a positive identification; 47.5% within 6 months here.
- Immediate ART
- Intervention-arm offer of ART to all HIV-positive adults regardless of CD4 count.
- CD4 ≤350 guideline ART
- Control-arm ART start per then-current South African guidelines.
- ANRS 12249
- Cluster-randomised TasP trial in rural KwaZulu-Natal (ClinicalTrials.gov NCT01509508).
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Registered eligible adults numbered about:
Common questions
How many people were registered and contacted?
12,894 eligible adults; 9,927 (77.0%) contacted at least once.
What was baseline HIV prevalence?
30.5% (2,028/6,656; 95% CI 25.0–37.0%).
How fast was linkage to care?
47.5% visited a trial clinic within 6 months; nearly two-thirds by 12 months.
Was immediate ART acceptable?
Yes—89% of intervention-arm clinic attenders started ART within 3 months; 93% wanted prompt ART if positive.
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