To achieve 95-95-95 targets we must reach men and youth: High level of knowledge of HIV status, ART coverage, and viral suppression in the Botswana Combination Prevention Project through universal test and treat approach

Refeletswe Lebelonyane, Pamela Bachanas, Lisa Block, Faith Ussery, Mary Grace Alwano, Tafireyi Marukutira, Shenaaz El Halabi, Michelle Roland, William Abrams, Gene Ussery, James A Miller, Shahin Lockman, Tendani Gaolathe, Molly Pretorius Holme, Shannon Hader, Lisa A Mills, Kathleen Wirth, Naomi Bock, Janet Moore, Refeletswe Lebelonyane, Pamela Bachanas, Lisa Block, Faith Ussery, Mary Grace Alwano, Tafireyi Marukutira, Shenaaz El Halabi, Michelle Roland, William Abrams, Gene Ussery, James A Miller, Shahin Lockman, Tendani Gaolathe, Molly Pretorius Holme, Shannon Hader, Lisa A Mills, Kathleen Wirth, Naomi Bock, Janet Moore

Abstract

Background: Increasing HIV treatment coverage is crucial to reducing population-level HIV incidence.

Methods: The Botswana Combination Prevention Project (BCPP) was a community randomized trial examining the impact of multiple prevention interventions on population-level HIV incidence and was conducted from October 2013 through June 2017. Home and mobile campaigns offered HIV testing to all individuals ≥ age 16. All identified HIV-positive persons who were not on antiretroviral therapy (ART) were referred to treatment and tracked to determine linkage to care, ART status, retention in treatment, and viral suppression.

Results: Of an estimated total of 14,270 people living with HIV (PLHIV) residing in the 15 intervention communities, BCPP identified 13,328 HIV-positive persons (93%). At study start, 10,703 (80%) of estimated PLHIV knew their status; 2,625 (20%) learned their status during BCPP, a 25% increase with the greatest increases occurring among men (37%) and youth (77%). At study start, 9,258 (65%) of estimated PLHIV were on ART. An additional 3,001 persons started ART through the study. By study end, 12,259 had initiated and were retained on ART, increasing coverage to 93%. A greater increase in ART coverage was achieved among men (40%) compared to women (29%). Of the 11,954 persons who had viral load (VL) test results, 11,687 (98%) were virally suppressed (HIV-1 RNA ≤400 copies/mL). Overall, 82% had documented VL suppression by study end.

Conclusions: Knowledge of HIV-positive status and ART coverage increased towards 95-95 targets with universal testing, linkage interventions, and ART. The increases in HIV testing and ART use among men and youth were essential to reaching these targets.

Clinical trial number: NCT01965470.

Conflict of interest statement

There are no competing interests declared by the authors. Lisa Block, Gene Ussery, and James Miller were employed by Northrup Grumman during this study. However, there are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. HIV care cascade among HIV-infected…
Fig 1. HIV care cascade among HIV-infected adults in 15 intervention communities.
Fig 2. Knowledge of HIV-positive status, ART…
Fig 2. Knowledge of HIV-positive status, ART status, and viral suppression stratified by age and sex.

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