In summary, the main hypothesis of the Tas P trial is that HIV testing of all adult members of a community, followed by immediate ART initiation of all, or nearly all, HIV-infected participants regardless of immunological or clinical staging, will prevent onward transmission and reduce HIV incidence in this population.
The Tas P trial is a cluster-randomised trial implemented in the Hlabisa sub-district, in rural northern Kwa Zulu-Natal in South Africa, an area with approximately 228 000 Zulu-speaking inhabitants.
Triangulation of social science studies within the ANRS 12249 Tas P trial will provide comprehensive insights into the acceptability and feasibility of the Tas P intervention package at individual, community, patient and health system level, to complement the trial’s clinical and epidemiological outcomes.
It will also increase understanding of the causal impacts of UTT on social and economic outcomes, which will be critical for the long-term sustainability and routine UTT implementation.
statistically significant reductions in HIV incidence) necessary to warrant taking UTT interventions to scale are obtained only when very high levels of uptake of the two key components of the UTT strategy are achieved and sustained – as high as 90% of HIV-negative people tested for HIV every year and 90% of HIV-infected people starting ART .
Yet data published so far, highlight the challenge of reaching such high uptake rates of HIV testing and HIV care, even before considering a UTT strategy itself.The Universal HIV Test and Treat (UTT) strategy represents a challenge for science, but is also a challenge for individuals and societies.Are repeated offers of provider-initiated HIV testing and immediate antiretroviral therapy (ART) socially-acceptable and can these become normalized over time?And can UTT be implemented within capacity constraints and other threats to the overall provision of HIV services?The answers to these research questions will be critical for routine implementation of UTT strategies.A social science research programme is nested within the ANRS 12249 Treatment-as-Prevention (Tas P) cluster-randomised trial in rural South Africa.The programme aims to inform understanding of the (i) social, economic and environmental factors affecting uptake of services at each step of the continuum of HIV prevention, treatment and care and (ii) the causal impacts of the Tas P intervention package on social and economic factors at the individual, household, community and health system level.A recent meta-analysis of home-based voluntary HIV testing in sub-Saharan Africa showed that the proportion of people who accept home-based HIV testing ranged from 58.1% to 99.8% overall (pooled percentage 83.3%), and from 58.1 to 91.8% in South Africa specifically .This review did not present data on repeat HIV testing, however the few available reports on uptake of consecutive HIV testing campaigns show a 75-80% uptake of a second test among those tested the first time [12,13].We constructed a multi-disciplinary research programme implemented as part of the ANRS 12249 Treatment-as-Prevention (Tas P) trial in South Africa.In this paper, we first briefly present the overall trial design.