ArticleAIDS (London, England)2018
Impact of early antiretroviral therapy eligibility on HIV acquisition: household-level evidence from rural South Africa.
Article in AIDS (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Why do people living with HIV not initiate treatment? A systematic review of qualitative evidence from low- and middle-income countries.Social science & medicine (1982) · 2018Pooled it
- Regression Discontinuity and Randomized Controlled Trial Estimates: An Application to The Mycotic Ulcer Treatment Trials.Ophthalmic epidemiology · 2018Trial
- Linkage of HIV treatment and population-based surveillance records in rural South Africa: the AHRI Unified Data Platform (AUDP).Archives of public health = Archives belges de sante publique · 2026Article
- Article
- HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study.Frontiers in public health · 2023Article
- Article
- Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort.Current HIV/AIDS reports · 2020Review
- Perceived Knowledge of HIV-Negative Status Increases Condom Use Among Female Sex Workers in Zambian Transit Towns.AIDS patient care and STDs · 2020Article
- Why Everyone (Almost) with HIV Needs to Be on Treatment: A Review of the Critical Data.Infectious disease clinics of North America · 2019Review
- Is knowledge of HIV status associated with sexual behaviours? A fixed effects analysis of a female sex worker cohort in urban Uganda.Journal of the International AIDS Society · 2019Article
- Effect of ART scale-up and female migration intensity on risk of HIV acquisition: results from a population-based cohort in KwaZulu-Natal, South Africa.BMC public health · 2019Observational
- Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa.Tropical medicine & international health : TM & IH · 2018Observational
Corrections and comments
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Authors and funding
12 authors at 7 institutions in 4 countries.
Funding
Abstract
objectivesWe investigate the effect of immediate antiretroviral therapy (ART) eligibility on HIV incidence among HIV-uninfected household members.
designRegression discontinuity study arising from a population-based cohort.
methodsHousehold members of patients seeking care at the Hlabisa HIV Treatment and Care Programme in rural KwaZulu-Natal South Africa between January 2007 and August 2011 with CD4 cell counts up to 350 cells/μl were eligible for inclusion if they had at least two HIV tests and were HIV-uninfected at the time the index patient linked to care (N = 4115). Regression discontinuity was used to assess the intention-to-treat effect of immediate versus delayed ART eligibility on HIV incidence among household members. Exploiting the CD4 cell count-based threshold rule for ART initiation (CD4 < 200 cells/μl until August 2011), we used Cox proportional hazards models to compare outcomes for household members of patients who presented for care with CD4 cell counts just above versus just below the ART initiation threshold.
resultsCharacteristics of household members of index patients initiating HIV care were balanced between those with an index patient immediately eligible for ART (N = 2489) versus delayed for ART (N = 1626). There were 337 incident HIV infections among household members, corresponding to an HIV incidence of 2.4 infections per 100 person-years (95% confidence interval 2.5-3.1). Immediate eligibility for treatment reduced HIV incidence in households by 47% in our optimal estimate (hazard ratio = 0.53, 95% confidence interval 0.30-0.96), and by 32-60% in alternate specifications of the model.
conclusionImmediate eligibility of ART led to substantial reductions in household-level HIV incidence.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.