Abstract
To achieve UNAIDS 90:90:90 targets at population-level, knowledge of HIV status must be followed by timely linkage to care, initiation and maintenance of antiretroviral therapy (ART) for all people living with HIV (PLHIV). Interpreting quantitative patterns using qualitative data, we investigate time taken to link to care and initiate ART amongst individuals aware of their HIV-status in high HIV-prevalence urban communities in the HPTN 071 (PopART) study, a community-randomised trial of a combination HIV prevention package, including universal testing and treatment, in 21 communities in Zambia and South Africa. Data are drawn from the seven intervention communities where immediate ART irrespective if CD4 count was offered from the trial-start in 2014. Median time from HIV-diagnosis to ART initiation reduced after 2 years of delivering the intervention from 10 to 6 months in both countries but varied by gender and community of residence. Social and health system realities impact decisions made by PLHIV about ART initiation.
Highlights
The dual role of anti-retroviral treatment (ART) for HIV treatment and prevention is well established [1,2,3]
In 2014 UNAIDS and partners set global HIV testing and ART coverage targets to drive policy makers towards enhancing access to treatment for all people living with HIV (PLHIV) [4]
The estimated median time from CHIP referral to ART initiation was ~ 6 months in Round 2 in both Zambia and South Africa, considerably less than the median of ~ 10 months in both countries in Round 1 but still slower than had been targeted at the start of the intervention (Fig. 1a; the horizontal red line is drawn at 50% to correspond to the median time to ART initiation)
Summary
The dual role of anti-retroviral treatment (ART) for HIV treatment and prevention is well established [1,2,3]. Mathematical models predicted that a public health approach of universal HIV testing with immediate ART treatment for all identified HIV-positive individuals has AIDS and Behavior (2019) 23:929–946 the capacity to reduce HIV incidence [11], the populationwide delivery of this strategy is challenging [12]. This is so in high burden, resource-constrained settings [13,14,15] despite some recent encouraging results from combination interventions [16, 17]
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