No effect of test and treat on sexual behaviours at population level in rural South Africa.

Matthieu Rolland,Deenan Pillay,Joseph Larmarange,Nuala Mcgrath,Joanna Orne-Gliemann,Thierry Tiendrebeogo,François Dabis

doi:10.1097/qad.0000000000002104

Abstract

Context:Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms.Methods:As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.Results:CLS with regular partner varied between 29–51% and 23–46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5–12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24–5.45)].Conclusion:Universal Test and Treat was not associated with increased sexual risk behaviours.

Highlights

Manuscript Introduction Universal antiretroviral therapy (ART) at high CD4 counts reduces morbidity and mortality rates among people living with HIV 1,2 and reduces the risk of transmission to HIV-negative partners 3
A full model was computed for each indicator. This model included trial arm, which represents the baseline difference between arms; trial round, which represents the effect over time of the trial interventions implemented in both arms; an interaction term between trial arm and trial rounds, which represents the specific effect over time of universal ART implemented in the intervention arm only; and calendar round, which represents the structural change over time in the study area
In this study we reported on the impact of universal ART on sexual behaviours at population-level in rural South Africa

Summary

Introduction

Manuscript Introduction Universal antiretroviral therapy (ART) at high CD4 counts reduces morbidity and mortality rates among people living with HIV 1,2 and reduces the risk of transmission to HIV-negative partners 3.

Results

Conclusion