Study Shows Promise Improving HIV Diagnoses and Treatment Uptake

Research seeks to improve the impact of household-based HIV testing and the link to care by community HIV care providers.

The second round of the PopART (HPTN 071) study shows promise achieving the 90-90-90 initiative goals: 90% of individuals with HIV are diagnosed, 90% of patients are on treatment, and 90% are virally suppressed.

PopART is a large community, randomized trial conducted in Zambia and KwaZulu-Natal, South Africa, according to NAM. The goal of the study was to compare the impact of HIV incidence of household-based HIV testing and the link to care by community HIV care providers (CHiPs), and immediate initiation of antiretroviral therapy (ART) delivered through routine health care services to the standard of care.

After the first round of the study, 53% of individuals diagnosed in Zambia had started treatment within 12 months. The second round of the study included 110,755 adults, of whom 65% were men and 87% were women.

The investigators estimated the total number of adults living with HIV based on the prevalence of the virus among those who were tested.

The investigators concluded that 6249 men and 10,341 women were living with HIV, of whom, 78% of men with HIV and 90% of women with HIV had been diagnosed.

HIV-positive men remained less likely to be diagnosed than women after round 2, but there was significant improvement in the level of diagnosis in men. By the end of round 2, the results of the study showed that the proportion of men in all age bands diagnosed with HIV increased above 70% compared with less than 60% of individuals in the under 35 years’ bands diagnosed after round 1.

After round 2, men over 40 years remained more likely to be aware of their HIV-positive status, NAM reported.

For women, evidence of the age difference in diagnosis after the first round had largely disappeared after round 2. Furthermore, almost 90% of women knew their HIV status in all bands after round 2, according to NAM.

After round 2 was completed, an estimated 78% of diagnosed men and 79% of diagnosed women initiated ART. Although young men and women were less likely to be on ART, the uptake of treatment improved in both men and women in round 2.

Among the participants who reported starting on ART prior to the beginning of the second round, 92% of men and 95% of women had remained on ART at the time of contact to take part in round 2 of the study.

The investigators also observed improvements in the speed at which patients started treatment once referred for HIV care in round 2. In round 1, it took patients a median of 9 and a half months to start treatment after referral. The interval was reduced to 5 months in the second round, and the improvement was attributed to the increased focus among CHiPs on ensuring linkage to care and the improvement in coordination with clinics to ensure linkage.

The findings were presented last month at the Conference on Retroviruses and Opportunistic Infections (CROI 2017).