Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa

Mélanie Plazy (1, 2) , Kamal El Farouki (2) , Collins Iwuji (3, 4) , Nonhlanhla Okesola (4) , Joanna Orne-Gliemann (1) , Joseph Larmarange (5, 4) , France Lert (6) , Marie-Louise Newell (7, 8) , François Dabis (1) , Rosemary Dray-Spira (2)

1 ISPED - Institut de Santé Publique, d'Epidémiologie et de Développement
2 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
3 Research Department of Infection and Population Health [London]
4 Africa Centre for Health and Population Studies
5 CEPED - UMR_D 196 - Centre population et développement
6 CESP - Centre de recherche en épidémiologie et santé des populations
7 Global Health Research Institute
8 Human Health and Development

Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. Methods: Individuals ]16 years were offered HBHCT; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm. Results: Overall, 1323 HIV-positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n 0488) linked to care B3 months of referral (similar by sex). In adjusted analyses (n 01222), individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care (B33% vs. !42%, p B0.001). Linkage to care was lower in students (adjusted odds-ratio [aOR] 00.47; 95% confidence interval [CI] 0.24Á0.92) than in employed adults, in adults who completed secondary school (aOR 00.68; CI 0.49Á0.96) or at least some secondary school (aOR 00.59; CI 0.41Á0.84) versus 5 primary school, in those who lived at 1 to 2 km (aOR 00.58; CI 0.44Á0.78) or 2Á5 km from the nearest TasP clinic (aOR 00.57; CI 0.41Á0.77) versus B1 km, and in those who were referred to clinic after ]2 contacts (aOR 00.75; CI 0.58Á0.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR 01.45; CI 1.12Á1.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive (aOR 02.16; CI 1.13Á4.10) versus not. Conclusions: Fewer than 40% of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care. Keywords: HIV/AIDS; home-based HIV counselling and testing; linkage to care; universal test and treat; South Africa.

Mots clés: HIV/AIDS; South Africa; home-based HIV counselling and testing; linkage to care; universal test and treat

Domaines: Santé publique et épidémiologie

Mélanie Plazy, Kamal El Farouki, Collins Iwuji, Nonhlanhla Okesola, Joanna Orne-Gliemann, et al.. Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa. Journal of the International AIDS Society, 2016, 19 (1), pp.20913. ⟨10.7448/IAS.19.1.20913⟩. ⟨hal-01331185⟩