The HIV Prevention Trials Network (HPTN) commends the participants and researchers on successful completion of the ANRS 12249 TasP (Treatment as Prevention) Study. The study was conducted in a rural area of northern KwaZulu-Natal (South Africa) where HIV incidence was compared between communities randomized to either immediate offer of antiretroviral therapy (ART) for all individuals diagnosed with HIV, or standard of care ART initiation. Both study arms included home-based HIV testing.
The results of the ANRS 12249 study did not demonstrate an effect on HIV incidence of offering immediate ART. Nonetheless, the study provides numerous lessons learned about the challenges of achieving treatment as prevention at a population level in a rural setting in sub-Saharan Africa. In particular, the study demonstrates the key importance of achieving high rates of linkage to care following HIV diagnosis.
The study’s findings underscore the importance of the ongoing HIV Prevention Trials Network study HPTN 071, also known as PopART (Population Effects of Antiretroviral Therapy to reduce HIV Transmission). The HPTN 071 (PopART) study design, which is evaluating the effect of a combination HIV-prevention package, including home-based testing and offer of immediate ART for HIV-infected individuals on community-level HIV incidence, differs from ANRS 12249 in several respects. These include:
- The urban/peri-urban communities in HPTN 071 (PopART), the environment in which 40 percent of the population of sub-Saharan Africa now lives, represent a different setting from the rural communities in ANRS 12249, and there may be important differences in terms of effectiveness, strategies and cost.
- In HPTN 071 (PopART), only the intervention arm includes home-based testing, while both arms of ANRS 12249 included home-based testing. By comparing the PopART intervention to a control arm receiving the existing standard-of-care, HPTN 071 (PopART) will be able to assess the full impact on HIV incidence of home-based testing, linkage to care and immediate offer of ART, as well as other elements of the study’s combination HIV-prevention package.
- HPTN 071 (PopART) features a longer follow-up period than the ANRS 12249 study, thereby providing more time to assess the intervention’s effect on incidence.
The final results of HPTN 071, which is being conducted in 21 communities in Zambia and South Africa, are expected in 2018. Initial findings show that after one year, the PopART intervention has substantially increased the uptake of HIV testing and ART. These findings, and those also reported from the SEARCH trial at the AIDS 2016 conference, suggest that a “universal test-and-treat” (UTT) approach, delivered with the support of home-based testing, should help in delivering the UNAIDS 90-90-90 targets designed to bring the global HIV epidemic under control.
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