Fogel, Jessica M; Zewdie, Kidist; Clarke, William A; Piwowar-Manning, Estelle; Breaud, Autumn; Moore, Ayana; Kosloff, Barry; Shanaube, Kwame; van Zyl, Gert; Scheepers, Michelle; +8 more... Floyd, Sian; Bock, Peter; Ayles, Helen; Fidler, Sarah; Hayes, Richard; Donnell, Deborah; Eshleman, Susan H; HPTN 071 (PopART) Study Team; (2022) Antiretroviral Drug Detection in a Community-Randomized Trial of Universal HIV Testing and Treatment: HPTN 071 (PopART). Open forum infectious diseases, 9 (11). ofac576. ISSN 2328-8957 DOI: https://doi.org/10.1093/ofid/ofac576
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Abstract
BACKGROUND: Antiretroviral therapy (ART) reduces human immunodeficiency virus (HIV) transmission risk. The primary aim of this study was to evaluate ART uptake in a trial in Zambia and South Africa that implemented a community-wide universal testing and treatment package to reduce HIV incidence. METHODS: Study communities were randomized to 3 arms: A, combination-prevention intervention with universal ART; B, combination-prevention intervention with ART according to local guidelines; and C, standard of care. Samples were collected from people with HIV (PWH) during a survey visit conducted 2 years after study implementation: these samples were tested for 22 antiretroviral (ARV) drugs. Antiretroviral therapy uptake was defined as detection of ≥1 ARV drug. Resistance was evaluated in 612 randomly selected viremic participants. A 2-stage, cluster-based approach was used to assess the impact of the study intervention on ART uptake. RESULTS: Antiretroviral drugs were detected in 4419 of 6207 (71%) samples (Arm A, 73%; Arm B, 70%; Arm C, 60%); 4140 (94%) of samples with ARV drugs had viral loads <400 copies/mL. Drug resistance was observed in 237 of 612 (39%) viremic participants (95 of 102 [93%] with ARV drugs; 142 of 510 [28%] without drugs). Antiretroviral therapy uptake was associated with older age, female sex, enrollment year, seroconverter status, and self-reported ART (all P < .001). The adjusted risk ratio for ART uptake was similar for Arm A versus C (1.21; 95% confidence interval [CI], .94-1.54; P = .12) and Arm B versus C (1.14; 95% CI, .89-1.46; P = .26). CONCLUSIONS: At the 2-year survey, 71% of PWH were on ART and 94% of those participants were virally suppressed. Universal testing and treatment was not significantly associated with increased ART uptake in this cohort.
Item Type | Article |
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Faculty and Department |
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology Faculty of Infectious and Tropical Diseases > Dept of Clinical Research |
PubMed ID | 36447611 |
Elements ID | 197044 |
Official URL | http://dx.doi.org/10.1093/ofid/ofac576 |
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