Abstract
Objective:To determine the impact of a community-wide combination HIV-prevention package (PopART Intervention) that includes universal testing and treatment (UTT) on knowledge of HIV status, among adolescents aged 15--19 years.Design:The HPTN 071 (PopART) for Youth (P-ART-Y) study was nested within HPTN 071 (PopART), a three-arm, cluster-randomized trial conducted from 2013 through 2018 in 21 communities in Zambia and South Africa. Communities were randomly assigned to arm A (combination prevention intervention with universal ART), arm B (prevention intervention with ART provided according to local guidelines), or arm C (standard-of-care).Methods:Knowledge of HIV status was measured using data collected during the third round of the PopART intervention in arms A and B (October 2016 to December 2017) and by conducting a cross-sectional survey (August to November 2017) in arm C communities to provide comparative data. The survey was conducted among ∼200 randomly selected adolescents in each community. We used linear regression of the 21 community-level values to make comparisons among trial arms.Results:Knowledge of HIV status was 78.2% (23 544/30 089) in arm A and 76.0% (24 417/32 148) in arm B communities, compared with 32.9% (698/2120) in arm C communities. Knowledge of HIV status varied by country, triplet, sex, and age. The adjusted mean difference was 42.3% between arm A with arm C, 95% CI 28.1–56.6, P less than 0.001 and 40.4% between arm B with arm C, 95% CI 24.6–56.2, P < 0.001).Conclusion:Implementation of a community-wide combination HIV-prevention package that includes UTT substantially enhanced knowledge of HIV status among adolescents.
Highlights
Adolescents and young people (AYP) represent a growing proportion of people living with HIV (PLHIV) worldwide [1]
We report the impact of a community-wide combination HIV-prevention package that includes universal testing and treatment (UTT) on knowledge of HIV status among adolescents aged 15–19 years
Study design and population The PopART for Youth (P-ART-Y) study was nested within the HPTN 071 (PopART) trial, a three-arm community randomized trial implemented in 12 communities in Zambia and nine communities in South Africa that evaluated the impact of a combination prevention strategy, including UTT on HIV incidence at population level [7]
Summary
Adolescents and young people (AYP) represent a growing proportion of people living with HIV (PLHIV) worldwide [1]. In 2017 alone, 590 000 AYP between the ages of 15–24 were newly infected with HIV, of whom 250 000 were adolescents between the ages of 15 and 19 years [2]. Eastern and Southern Africa Region (ESAR) remains the region most affected by the HIV epidemic, accounting for 45% of the world’s HIV infections and home to approximately 60% of the world’s adolescents aged 10–19 years who are living with HIV [1]. A considerable proportion of adolescents living with HIV (ALHIV) in ESAR are unaware of their HIV status. The percentage of HIV-positive youths who knew their HIV-positive status (UNAIDS ‘first 90’) was one of the key gaps identified in these surveys
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