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ABSTRACT: Objective(s)
We sought to determine whether universal 'test and treat' (UTT) can achieve gains in viral suppression beyond universal antiretroviral treatment (ART) eligibility during pregnancy and postpartum, among women living with HIV.Design
A community cluster randomized trial.Methods
The SEARCH UTT trial compared an intervention of annual population testing and universal ART with a control of baseline population testing with ART by country standard, including ART eligibility for all pregnant/postpartum women, in 32 communities in Kenya and Uganda. When testing, women were asked about current pregnancy and live births over the prior year and, if HIV-infected, had their viral load measured. Between arms, we compared population-level viral suppression (HIV RNA <500 copies/ml) among all pregnant/postpartum HIV-infected women at study close (year 3). We also compared year-3 population-level viral suppression and predictors of viral suppression among all 15 to 45-year-old women by arm.Results
At baseline, 92 and 93% of 15 to 45-year-old women tested for HIV: HIV prevalence was 12.6 and 12.3%, in intervention and control communities, respectively. Among HIV-infected women self-reporting pregnancy/live birth, prevalence of viral suppression was 42 and 44% at baseline, and 81 and 76% (P = 0.02) at year 3, respectively. Among all 15 to 45-year-old HIV-infected women, year-3 population-level viral suppression was higher in intervention (77%) versus control (68%; P < 0.001). Pregnancy/live birth was a predictor of year-3 viral suppression in control (P = 0.016) but not intervention (P = 0.43). Younger age was a risk factor for nonsuppression in both arms.Conclusion
The SEARCH intervention resulted in higher population viral suppression among pregnant/postpartum women than a control of baseline universal testing with ART eligibility for pregnant/postpartum women.
SUBMITTER: Kabami J
PROVIDER: S-EPMC7360881 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
Kabami Jane J Balzer Laura B LB Saddiki Hachem H Ayieko James J Kwarisiima Dalsone D Atukunda Mucunguzi M Charlebois Edwin D ED Clark Tamara D TD Koss Catherine A CA Ruel Theodore T Bukusi Elizabeth A EA Cohen Craig R CR Musoke Phillipa P Petersen Maya L ML Havlir Diane V DV Kamya Moses R MR Chamie Gabriel G
AIDS (London, England) 20200701 9
<h4>Objective(s)</h4>We sought to determine whether universal 'test and treat' (UTT) can achieve gains in viral suppression beyond universal antiretroviral treatment (ART) eligibility during pregnancy and postpartum, among women living with HIV.<h4>Design</h4>A community cluster randomized trial.<h4>Methods</h4>The SEARCH UTT trial compared an intervention of annual population testing and universal ART with a control of baseline population testing with ART by country standard, including ART elig ...[more]