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HPTN 071 (PopART) Social Science
Overview
Virginia Bond, Graeme Hoddinott,
Janet Seeley, James Hargreaves, Anne Stangl
SSUTTN Satellite
IAS Durban
Monday 18th June
U.S. NATIONAL INSTITUTES OF HEALTH:
National Institute of Allergy and Infectious Diseases
National Institute of Mental Health
National Institute on Drug Abuse
THE TRIAL
HPTN 071 – PopART
2012-2018
– large-scale 3-arm, community randomised trial
assessing the effect of universal, immediate
access to ART on HIV infection rates in 21
community sites in Zambia (12) and South
Africa (9)
– combination prevention intervention approach:
annual door to door HIV counselling and
testing, linkage to care and other services
JANET SEELEY, JAMES HARGREAVES,
ANNE STANGL, SHARI KRISHNARATNE,
LINDSEY REYNOLDS
JANET SEELEY, JAMES HARGREAVES,
ANNE STANGL, SHARI KRISHNARATNE,
LINDSEY REYNOLDS
SOCIAL SCIENCE TEAM:
ZAMBIA
VIRGINIA BOND, MUSONDA
SIMWINGA, TILA
MAINGA, BWALYA CHITI,
DEBORAH MILIMO,
RHODA NDUBANI, FRED
NGWENYA, MELVIN
SIMUYABA, DANIEL
ZIBA + 8 RAS
JANET SEELEY, JAMES HARGREAVES,
ANNE STANGL, SHARI KRISHNARATNE,
LINDSEY REYNOLDS
SOCIAL SCIENCE TEAM:
ZAMBIA
VIRGINIA BOND, MUSONDA
SIMWINGA, TILA
MAINGA, BWALYA CHITI,
DEBORAH MILIMO,
RHODA NDUBANI, FRED
NGWENYA, MELVIN
SIMUYABA, DANIEL
ZIBA + 8 RAS
SOCIAL SCIENCE TEAM:
SOUTH AFRICA
GRAEME HODDINOTT, LARIO
VILJOEN, ABIGAIL HARPER,
CONSTANCE MUBEKAPIMUSADAIDZWA, JABULILE
BALENI, NOSIVUYILE
VANQA, HANLIE MYBURGH,
LAING DE VILLIERS,
ANGELIQUE THOMAS, ROSE
BROWN, GABRIELA
CAROLUS, LUBABALO
MDEDETYANA, SINAZO
NOMSENGE, CHULUMANCO
MDINGI, DIONNE JIVAN,
THANDO WONXIE + 13 RAS
History of Involvement
Main components
Methodology
History of Involvement
- Concept (2011)
- Main Protocol + formative research (2012)
- Ancillary Studies:
- Stigma (2013)
- Adolescents (2015)
- Community ART Delivery (Zambia only - 2015)
Social Science: Research Plan
HPTN 071 (PopART) Trial Social Science
Phase 1
Broad Brush Surveys
(BBS) – Rapidly
describe community
and health service
context in each study
community
Dec 2012 – May 2013
Phase 2
‘During Trial’ Social Science –
Document study implementation and community responses to this,
and contextualise study procedures and outcomes
in relation to a variety of social factors.
Aim 2 –
‘Ethnography of HIV
landscape’
Aim 1 –
‘Story of the trial’
Oct 2013 – Nov 2018
Stigma Ancillary: 2013-18
• Mixed-methods evaluation nested within HPTN 071 (PopART)
[Hargreaves et al., 2016, Health Policy and Planning]
• Prospective data collection over 4 years
• Quantitative (self-administered survey) and qualitative data
• Emphasis on “parallel assessments” of phenomena from multiple
perspectives (community, health workers, PLWH)
• Key questions:
– Does UTT reduce HIV-related stigma?
– Does UTT change the nature of and/or increase HIV-related
stigma?
– Does HIV-related stigma pose challenges to the delivery and/or
success of UTT?
• Baseline data analysis ongoing, year 2 data collected
2014 - 2017
2012 - 2013
1.
2.
3.
After 2017
HPTN 071 population cohort (PC) study
1.
PopART intervention
implementation
2.
Protocol
development
Community
buy-in
Formative
research
3.
Social Science Led:
1. The ‘Story of the
Trial’
2. Ethnography of
HIV
3. Stigma Ancillary
Triangulate social
science findings
with primary and
secondary outcomes
Recommendations
for roll-out and
application
Highlight & support
the role of
community
Social Science Supported:
- PopART economic evaluation
- Case-control studies
- Adolescents and UTT
- Population Cohort
- Community ART Delivery
Methodology
• Inter-disciplinary
– social science led + a component within
– mix/range of social science disciplines
• Different to but working with Community
Engagement + M&E
• To scale (21 communities, 2 countries)
– shallow & wide AND narrow & deep
•
•
•
•
Preceding, during, at the end, beyond*
Systematic, comparative
Responsive to intervention issues
Capacity-building
SOCIAL SCIENCE TYPES OF DATA
KEY THEME:
CHANGING HIV LANDSCAPE
e.g. Impact of Local Context
• Visible differences in context, process indicators and
community response across countries and communities
• E.g. analysis of process indicators in 4 Zambian Arm A
communities, ‘The difference that makes a difference’
[Bond, Chiti et al., 2016, AIDS Care] identifies influence of:
• proportion of middle class residents
• proximity to neighbouring communities and town
centre
• the scale of the informal economy
• livelihood-linked mobility
• presence of HIV stakeholders over time
• commitment to community action
e.g. Evolving Stigma
•
•
•
•
•
•
Opportunity to assess impact of UTT and ART on stigma
Persistent
More hidden and nuanced
Conflated
Very little specific stigma reduction
Changed
– prejudice towards groups [Krishnaratne et al., TUPED389, 2016]
– stigma and health facility space [Bond et al., TUPED388, 2016]
– Parallel measures: community, health workers, PLWH [Stangl et
al., forthcoming]
– High levels of stigma (including internalised) in community &
amongst health workers [Hargeaves et al., forthcoming]
e.g. Local discourse
‘Auntie Mona’s love advice’ [Viljoen, Hoddinott et al., 2016, AIDS Care]
ACKNOWLEDGEMENTS
•
Sponsored by the National Institute of Allergy and Infectious
Diseases (NIAID) under Cooperative Agreements # UM1
AI068619, UM1-AI068617, and UM1-AI068613
•
Funded by:
– The U.S. President's Emergency Plan for AIDS Relief
(PEPFAR)
– The International Initiative for Impact Evaluation (3ie) with
support from the Bill & Melinda Gates Foundation
– NIAID, the National Institute of Mental Health (NIMH), and
the National Institute on Drug Abuse (NIDA) all part of the
U.S. National Institutes of Health (NIH)
– NIMH specifically fund the Stigma Ancillary
The HPTN 071 Study Team, led by:
Dr. Richard Hayes
Dr. Sarah Fidler
Dr. Helen Ayles
Dr. Nulda Beyers
Government Agencies:
PEPFAR Implementing Partners:
With thanks to:
• All research participants and their families
• The 21 research communities and their religious, traditional, secular and civil
leadership structures
• Volunteers in the community advisory board structures
18 03 2016
Durban AIDS 2016, SSUTT satellite, July 18th, 2016
The MaxART Early Access to ART for all (EAAA) implementation study
in Swaziland
Ria Reis
LUMC, Dept. Public Health and Primary Care
University of Amsterdam, Dept. Anthropology
University of Cape Town, The Children’s Institute
On behalf of the MaxART social science team
Background MaxART
• Highest HIV prevalence and
highest TB incidence in the world
• ART program since 2004
• National Emergency Response
Council on HIV and AIDS
(NERCHA) since 2011
• 2011: MaxART consortium
established under leadership
of Swaziland’s MOH
• 2012: MOH adopted TasP
framework
• 2014 two UTT trials ongoing
MaxAR
T EAAA
MSF
EAAA
Source: HIV Annual Report 2014
Phase 1, 2011-2014
Ensuring access to treatment
at the current threshold,
supported by research
Phase 2, 2014-2017
EAAA Implementation study
Responding to realities and need on the ground
Four doctoral Social Science studies (predominantly qualitative approach)
 Thandeka Dlamini:
• Clients’ reasons for discontinuation of pre-ART.
 Alfred Adams:
• Reasons for low uptake of male circumcision & Low Utilization of HIV Services,
Client attrition and Sexuality in the Continuum of Care among Men.
 Fortunate Shabalala:
• Adolescents’ access to HIV services and how Adolescents living with HIV navigate
the social environment and health system.
 Eva Vernooij:
• Social and cultural processes influencing the making of EAAA in Swaziland by
studying how the intervention becomes translated and implemented in practice
Phase 1, 2011-2014
Ensuring access to treatment
at the current threshold,
supported by research
Phase 2, 2014-2017
EAAA Implementation study
Study Design
 3-year randomized stepped wedge design
 14 facilities in one region grouped into 7 steps (2 facilities per step)
 Open enrollment for all HIV+ adults ≥ 18 years of age, excluding pregnant and
breastfeeding women
Research
Five key points to be analyzed
within Swaziland’s governmentmanaged health system:
1. Feasibility
2. Affordability
3. Scalability
4. Acceptability
5. Clinical Outcomes
Social Science Research
Analysing social and cultural processes
Objective:
1. What are the differences in health service delivery before and after
the implementation of the intervention? How are these differences
impacting ART initiation?
2. What are the differences in the social, economic, and structural
factors between clients who have initiated on ART prior to and
during the study?
How do these differences impact adherence and retention?
Methods: participant observation, semi-structured
interviews with health care providers, quantitative survey
and qualitative in-depth interviews with HIV positive clients
Social Science Survey - sample size to date
Baseline
EAAA (T1)
EAAA (T2)
•ART patients initiated as per standard of care at < 12 months on ART
•Target N=380 across 9 facilities
•Actual N=369 across 9 facilities
•EAAA clients initiated on ART during transition or intervention, CD4>350 and WHO clinical stage 1
or 2 or missing. Willing to be contacted at < 12 months on ART
•Target N=380 across 8 facilities
•Progress to date N=111 entered across 4 facilities.
•Follow up of EAAA clients recruited in previous survey at 6 months
•Progress to date N= 76 (data not yet entered in database)
Qualitative work: Cross-cutting theme
 Studying how a public health and medical approach
becomes implemented in practice (making of TasP)
 … and translated and transformed in the process.
 How this transformation impacts implementation
Focus is on:
 In-depth understanding of motivations and behaviour
 Ways in which these are culturally grounded in
fundamental notions of personhood, responsibilities
and belonging
Eva Vernooij: Access for all, contextualizing HIV treatment as prevention
in Swaziland
 Insights from people living with HIV and key actors involved in designing
health communication messages
 “There are causes for Soka Uncobe not to work: it was foreign (…) they came
with the idea of a movement (…) and they will just tell the king to tell every
man to circumcise. Never in the history of Swaziland a king has actually told
anyone to do anything in treatment, in health issues, nor in agriculture issues,
nor in works or whatever I can mention”
 Misconception of Swazi leadership, including Kingship as top-down and
absolute
 “Today, we know that when I am on treatment and my partner is not, I infect
her with a worse HIV strand and you may find that by the time she starts the
treatment her HIV”
 “My husband knows that I take them [ART] (…). On the issue that the chances
of infecting others will be reduced (…) as long as people are unfaithful, I don’t
see it working. Because he will sleep around without a condom and come back
with a drug resistant virus… as a wife [I tell you]: Mind your own life, worry not
about him sleeping around
 Locally ascribed meanings were concerned with taking responsibility for
one’s own and one’s partner’s health, and treatment as prevention did not
fit in well with local biomedical knowledge, kinship dynamics, and secrecy
Fortunate Shabalala
MaxART Social Science Researcher &
PhD candidate
Longing for Belonging
Experiences of adolescents living with HIV
in different family contexts in Swaziland
Two-fold objectives:
• To get an indepth understanding of barriers to
access to HIV services by adolescents
• How adolescents living with HIV navigate the
social and health systems environment to
access HIV
Methodological approach…
• Design: mixed methods study
– 18 months ethnographic research (observations,
FGDs, IDIs, informal conversations, questions,
diary entries*)
– 6 months quantitative survey (researcher
administered questionnaire)
• Setting: two sites (one rural and one urban)
• Population:
– primary : in and out of school adolescents
– Secondary: parents, teachers, community leaders,
health care providers (in clinics and community),
programme managers
Key finding
• Meaning of family and being cared for
• Need for belonging (connected and
accepted unconditionally)
– Family Identity (patrilineage)
– Peer/Therapeutic identity ( support
groups)
Thank you!
The MaxART programme is led by the Ministry of
Health, Government of the Kingdom of Swaziland
with financial support of the Dutch Postcode Lottery
Fund. Additional support was received from the
Embassy of the Kingdom of the Netherlands in
Mozambique, Mylan, MSF Swaziland and the British
Columbia Centre for Excellence in HIV/AIDS.
Design Updates, Social Science
Research Agenda, and Emergent
Findings on Gender & Stigma
Edwin Charlebois, Carol S. Camlin, and Irene Maeri
Social Science of Universal HIV Test & Treat Network
(SSUTTN) Workshop, 17 July 2016
Durban, South Africa
The SEARCH “Package” to Achieve
UNAIDS 90/90/90
Community
Commitment
Census
SOC+
INTERVENTION
Community
Commitment
Census
16
communities
POPULATION
Baseline multidisease health
CHC + HH testing
Standard linkage and
ART/NCD start
1. Annual CHC +
HH multidisease testing
2. Additional
testing key
populations
1. Rapid linkage,
reminders, same day
ART start
2. Provider access
3. Tiered
tracking/feedback
90%
HIV +
tested
TEST
HIV-centric
standard monitoring
and tracking
1. Chronic diseasecentric
2. Patient centered
3. Provider access
4. Streamlined care
(3 month refill, short
waits)
5. Tiered
tracking/feedback
90%
start
ART
90% HIV
UnDetectAble
LINK and
START ART
RETAIN and
SUPPRESS
SEARCH design first 2 phases: rural Uganda and Kenya
FIRST PHASE
SECOND PHASE
16 Intervention
Communities
16 Intervention
Communities
Intervention:
Baseline/yearly HIV testing
ART for all HIV+
Streamlined care
32
Communities
10,000/community
Randomize
Start
Endpoint 1:
HIV
incidence
Year 3
Endpoint 1
16 Control
Communities
Re-randomize
the original 32
communities
at Year 3
Intervention Second Phase
Baseline + targeted HIV testing
ART for all + streamlined care
Targeted linkage
Targeted PrEP/ART
Endpoint 2:
HIV
incidence
Year 6
Endpoint 2
16 Control
Communities
Active Control:
Baseline HIV testing
Country-guided ART
Active Control (Phase 2):
Baseline HIV testing
ART for all HIV+
Social Science Research in SEARCH
Household
SocioEconomic
Survey
Social
Network
Study
• Measure impact on outcomes in communities e.g.
livelihoods, schooling, subjective life expectancy,
aspirations
• Examine social network influences on individual
behaviors relevant to care cascade outcomes
(HIV testing, linkage to care, etc.)
• Deepen understanding of social, behavioral and
implementation mechanisms: why
Longitudinal
intervention/fails and how it works in diverse
Qualitative
settings
Study
• Methods: Annual in-depth interviews (cohorts of community
members, leaders & health care providers), participant
observation at CHCs, focus groups with CHC participants
Baseline Qualitative Findings:
Gendered Dimensions of HIV-related Stigma
• HIV stigma: persists & affects men and women differently
• “Men missing”: structural and cultural barriers to men’s
participation in testing campaigns
• Men’s livelihoods and mobility meant they were often away from
homesteads
• Male gender norms counter to care-seeking; valorizing risk-taking;
keep them disinterested and “test by proxy”
• Men more than women preferred HBT, but incentives, sports activities
and other features targeting men boosted participation
• “How Can I Tell”: High anticipated stigma among both HIV+ men
& HIV- women
• HIV+ women experienced negative consequences of disclosure more often
than men; consequences more severe
• HIV- women more often remained in HIV-discordant relationships
Emergent Qualitative Findings
• SEARCH precipitated new opportunities &
anxieties related to disclosure of HIV+ status
• Early signs that norms, beliefs and attitudes (HIV
stigma) are changing (Abstract # TUPED376)
• Benefits of ART embolden HIV+ individuals to openly engage in
care
• Many “advocates for ART” emerging in communities: HIV+ people
actively engaged in encouraging others to test
• HIV+ community members actively encourage other HIV+ people to
enroll, adhere to regimens and stay engaged in care
‘How can I tell?’: Consequences of HIV status Disclosure
among Couples in Eastern African Communities in the
Context of an Ongoing HIV ‘Test and Treat’ Trial
Introduction
•
•
PLWHA anticipate HIV-related stigma and fear disclosure to intimate
partners.
Study characterized HIV disclosure experiences and normative beliefs
among couples
Methods
•
In-depth interviews: care providers
(n=50), leaders (n=32) and community
members (n=112) of 8 communities in 3
regions of Uganda and Kenya
•
Data analyzed using grounded
theoretical approaches and
Atlas.ti software
FINDINGS
Gender differences in anticipated stigma
•
Female (HIV+): anxiety about partner abandonment,
relationship dissolution, and feared violent responses
“I did not tell my husband because I was thinking if he turns out to
be like the other ones that I hear about, I tell him, and he abandons
me at the last moment when I am in labor, how will I manage?”
Female community leader, Uganda, female
•
Male (HIV+): fears of accusation and blame due to
arguments surrounding male ‘promiscuity’.
•
Fear of abandonment only reported by HIV+ men in discordant
relationships
FINDINGS
Gender differences in strategies to avoid disclosure
Men often enrolled in HIV care without telling their partners
I realized that [my husband] and my co-wife were already on care.
[…] He was enrolled for care elsewhere and could not tell me.”
Female community member, Kenya, HIV-concordant
Women found difficulty starting care or adhering to
medications due to fear of their partners finding out
“If a pregnant woman tests positive for HIV and we give her drugs,
she is scared to tell her husband that she is positive; she fears to
take the drugs and hides them away from her husband and keeps
them at the neighbor’s place.” Provider, Uganda, female
FINDINGS
Negative consequences: significantly patterned by
gender
-
most severe consequences reported by women,
particularly in HIV-discordant partnerships- marital
dissolution, abandonment, blame, denying access to care,
and physical abuse.
“This was the greatest problem […] I tested positive after my first born and
my husband refused to use condoms and even threatened to marry
another wife [...] He insisted that if we must use condoms, then he ceases
to be called my husband and will not take responsibility of our children[…],
that I raise our children alone. This continued for five years without any
support from him.” Female community member, Kenya
FINDINGS
Positive consequences of disclosure:
- Increased ability to engage in HIV care
- Personal empowerment
- Encouragement of partners and others to test, engage
in care, and initiate ART
- Increased risk-reduction strategies.
“My husband keeps on reminding me ‘have you taken those
drugs?’[...] ‘Oh, thank you for reminding me, I was forgetting’,
even when I am busy listening to the radio.” Female community
member, Kenya
FINDINGS
Facilitators of Disclosure
Clinic-based couples testing a preferred strategy for
disclosure among women
“I decided to tell my husband, ‘For the sake of the
baby’s health, we have to know our HIV status’. He
didn‘t become stubborn so we all went to the hospital.
When we arrived, the doctor asked whether I was
going to be enrolled [in ART], and I told him that I
couldn't be enrolled first before knowing [my
husband’s] status.” Female community member,
Kenya
CONCLUSIONS
1. Differing experiences and support needs
of women and men living with HIV in
eastern Africa
2. HIV-positive women in discordant
couples particularly vulnerable to
negative consequences of disclosure
3. Gender-sensitive provider-assisted
disclosure should be accelerated within
test-and-treat efforts
Home-based HIV testing
and linkage to care
Lessons learned
from the ANRS 12249 TasP trial
AIDS 2016 Durban – SSUTTN satellite
Joanna Orne-Gliemann & Thembelihle Zuma for the TasP group
Overview ANRS 12249 TasP trial


Objective: Evaluate the impact of immediate ART on HIV
incidence at population level
Setting: Hlabisa sub-district, KwaZulu-Natal







1,430 Km2
228,000 Zulu speaking people
29% HIV prevalence
Design: Cluster-randomised trial, 22 clusters
(2x11), 26000 people
Timeline: March 2012-June 2016
Multidisciplinary consortium: Africa Centre, University of
Bordeaux, CEPED-IRD, SESSTIM University of Marseille
5 integrated working groups: social situations,
epidemiology/modelling, health systems/economics, clinical,
virology
Overview of the trial activities
Homestead
identification
(GPS)
Homestead visit
1. Study questionnaires
2. DBS sample, rapid HIV testing
3. TasP card
Overview of the trial activities
Homestead
identification
(GPS)
TasP clinic
- 1 per cluster (45mn walk max)
- HIV treatment and care
• Intervention arm: early ART
• Control arm: ART according
to national guidelines
- Study questionnaires
Homestead visit
1. Study questionnaires
2. DBS sample, rapid HIV testing
3. TasP card
HIV +
Referral to
TasP clinics
HIV -
Repeat HIV
test 6 mths
later
Social sciences research programme

Multidisciplinary, multi-level, mixed-methods programme
embedded within the trial
GENERAL
POPULATION
Home-based survey rounds
Every 6 months
Qualitative survey
First year
Household assets questionnaire &
Individual questionnaire (sociodemographics, sexual behaviour…)
Focus Group Discussions
In-depth interviews
Social sciences research programme

Multidisciplinary, multi-level, mixed-methods programme
embedded within the trial
GENERAL
POPULATION
PATIENTS
(HIV+)
Home-based survey rounds
Every 6 months
Qualitative survey
First year
Household assets questionnaire &
Individual questionnaire (sociodemographics, sexual behaviour…)
Focus Group Discussions
In-depth interviews
Clinic-based survey
Baseline, M6, M12….
Individual questionnaire
(adherence, support, QoL…)
Social sciences research programme

Multidisciplinary, multi-level, mixed-methods programme
embedded within the trial
GENERAL
POPULATION
PATIENTS
(HIV+)
HEALTH
SYSTEM
Home-based survey rounds
Every 6 months
Qualitative survey
First year
Household assets questionnaire &
Individual questionnaire (sociodemographics, sexual behaviour…)
Focus Group Discussions
In-depth interviews
Clinic-based survey
Baseline, M6, M12….
Individual questionnaire
(adherence, support, QoL…)
Health Care Professionnals survey
Endline
Health systems survey
Endline
Individual questionnaires
Focus Group Discussions, In-depth interviews
Cost, cost-effectiveness
Focus on the qualitative study
Conducted within the general population from the first 4 trial
clusters, Jan. 2013 to July 2014

Focus Group Discussions





51 participants aged 19-70
Recruited from households
(HIV status unknown from
researcher)
Mixed gender
Predefined age categories
 Younger adults (n=15)
 Older adults (n=16)
 Mixed age (n=11)
 Traditional health
Practitioners (THPs) (n=9)
Repeated with the same
participants, 4 times

Individual interviews



20 participants (10 men, 10
women) aged 17–64
Recruited from households
(HIV status unknown from
researcher) or from trial
clinics (HIV-positive and status
known by researcher)
Repeated interviews with 10
participants, 3 times


6 women (all positive)
4 men (2 positive, 1 negative,
1 unknown)
Main results (1)

Repeat and regular home-based HIV-testing well
perceived by the community (Orne-Gliemann et al, AIDS Care
special issue 2016)
Home-based testing > clinic-based testing because more
private, more confidential (not “seen” by the “outside”)
 Home-based testing best model to facilitate repeat and
regular HIV-testing



Quantitative data show high uptake of home-based HIV
testing (Iwuji et al, PlosMed 2016)
Main reason to test repeatedly is sexual risk-taking,
“misbehaviour”

Perceptions of stigma and prejudice regarding HIV and sexual
risk-taking
Main results (2)

THPs report issues with using clinics (Moshabela et al, AIDS
Care special issue 2016)
Fear of labelling, stigma and discrimination, implications of
unsolicited disclosure
 Home-based testing reported as a critical component of UTT
 Growing number of patients find sanctuary with THP
 THP struggling to channel patients back to clinics, though trying
to play an active role in linkage to care


Quantitative data show poor linkage to care: less than
50% of HIV-positive people identified had accessed a
clinic within 12m (Iwuji et al, PlosMed 2016)
Main results (3)

Men reported unwillingness to engage with HIV testing
and care (Chikovore et al, AIDS Care special issue 2016)
Pursuit of valued masculinity constructs
 Gendered-tension, blame on women (more disposed to test,
use condoms, access care freely, talk about HIV etc.)



Quantitative data show insufficient use of home-based
testing services among men (not offered because absent
during the day) (Larmarange et al, R4P conference 2014)
But do not suggest less linkage to care (Plazy et al., JIAS 2016)
or lower ART initiation among men vs women (Boyer et al, AIDS
Care special issue)
Lessons learned for UTT




Home-based HIV testing highly acceptable in this rural
population but not universal, need for diverse approaches
to HIV testing
Stigma associated with HIV clinics: HIV-positive people
need support to accept their status and to link to HIV care
and need differentiated/personalised HIV care
Take into account complex interaction of men with partners
and families in efforts to link men into care (counselling
content)
Need to strengthen ties between clinics – THPs (instrumental
in increasing community acceptability of linkage to care)
Lessons learned for UTT


Community-based qualitative research conducted in the early
stages of the trial
Understanding this data in light of the main results of the trial:
Dabis F. et al, “The impact of universal
test and treat on HIV incidence in a rural
South African population. ANRS 12249
TasP trial, 2012-2016”
Friday 22nd July, 11.00-12.30
Session room 12, Abstract FRACO105LB
Acknowledgements





Trial participants
Africa Centre staff
Traditional Authority
Department of Health, South Africa
Merck/Gilead
ANRS 12249 Study Group: Kathy Baisley, Eric Balestre, Till Bärnighausen, Sylvie Boyer, Alexandra Calmy,
Vincent Calvez, François Dabis (co-PI), Anne Derache, Hermann Donfouet, Rosemary Dray-Spira, Jaco
Dreyer, Andrea Grosset, Kobus Herbst, John Imrie, Collins Iwuji (Coordinator South), Joseph Larmarange,
France Lert, Richard Lessells, Thembisa Makowa, Anne-Genevieve Marcelin, Nuala McGrath, Marie-Louise
Newell (co-PI), Nonhlanhla Okesola, Tulio de Oliveira, Joanna Orne-Gliemann (Coordinator North),
Delphine Perriat, Deenan Pillay (co-PI), Mélanie Plazy, Camelia Protopopescu, Luis Sagaon-Teyssier, Bruno
Spire, Frank Tanser, Rodolphe Thiébaut, Thierry Tiendrebeogo, Thembelihle Zuma