Trial reportThe lancet. HIV2022
Viral suppression and self-reported ART adherence after 3 years of universal testing and treatment in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: a cross-sectional analysis.
Trial report in The lancet. HIV, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 10 citations in OpenAlex.
- Examining the effect of universal testing and treatment strategies for HIV prevention in Zambia and South Africa: generalizing the results of the HPTN 071 (PopART) trial.Journal of the International AIDS Society · 2025Trial
- Quantifying excess TB prevalence among people living with HIV on ART in the universal ART era: Evidence from a TB prevalence survey in Zambia and South Africa.PLOS global public health · 2026Article
- The effect of long-acting cabotegravir and rilpivirine treatment on drug resistance in South Africa: a modelling study.The Lancet. Global health · 2025Article
- Factors Associated with Non-Adherence to Antiretroviral Therapy: A Health-Facility-Based Cross-Sectional Study in the Amahlathi Sub-District of the Eastern Cape, South Africa.HIV/AIDS (Auckland, N.Z.) · 2025Article
- Viral suppression and associated factors after enhanced adherence counseling among people living with HIV with unsuppressed viral loads at tertiary and first-level health facilities in Zambia: A retrospective cohort study.PLOS global public health · 2025Article
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- Changes in access to viral load testing, incidence rates of viral load suppression and rebound following the introduction of the 'universal test and treat' guidelines in Cameroon: A retrospective follow-up analysis.PLOS global public health · 2024Article
- HIV viral suppression in the era of dolutegravir use: Findings from a national survey in Tanzania.PloS one · 2024Article
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Authors and funding
21 authors at 9 institutions in 4 countries.
Funding
Abstract
backgroundIn 2014, UNAIDS set the target that 90% of individuals on antiretroviral therapy (ART) be virally suppressed. Here, we use data from the HPTN 071 (PopART) trial to report whether the introduction of universal testing and treatment has affected viral suppression or treatment adherence among individuals who self-reported they were taking ART, and identify risk factors for these outcomes.
methodsThis was a cross-sectional study nested within the randomly selected population cohort of the PopART trial. The trial took place in 21 communities in Zambia and South Africa. Analyses included 3570 HIV-positive participants who were seen at the second follow-up visit in 2016-17 and who self-reported that they were currently taking ART. Viral suppression was defined as HIV RNA of less than 400 copies per mL from a blood sample collected during the cohort visit, and ART adherence was measured using self-reporting (reported as no missed pills in last 7 days). Prevalences of these outcomes were compared across three trial arms using a two-stage approach suitable for clustered data. Each arm consisted of seven communities, with one arm receiving a combination HIV prevention package including immediate ART initiation, one receiving a combination HIV prevention package excluding immediate ART initiation and one arm receving standard of care. Risk factors for each of the outcomes were assessed using logistic regression.
findingsAmong the 3570 participants who self-reported that they were currently on ART, 416 (11·7%) of 3554 were not virally suppressed (16 were missing viral suppression status) and 345 (9·7%) of 3566 reported being non-adherent to ART (four were missing adherence status). The proportion not virally suppressed was higher in communities in South Africa (195 [16·4%] of 1191) than in Zambia (221 [9·4%] of 2363). There was no evidence that the prevalence of the outcomes differed between trial arms. There was evidence that men, younger individuals, individuals who reported participating in harmful alcohol use, and those who reported internalised stigma were more likely to be non-adherent, and not virally suppressed.
interpretationThe results assuaged concerns that early ART initiation in a universal testing and treatment setting could lead to reduced adherence and viral suppression.
fundingUS National Institute of Allergy and Infectious Diseases (which is a part of the National Institutes of Health), the International Initiative for Impact Evaluation with support from the Bill & Melinda Gates Foundation, US President's Emergency Plan for AIDS Relief, and Medical Research Council UK.
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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.