Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART)

CITATION: Hayes, R. J. et al. 2019. Effect of Universal Testing and Treatment on HIV Incidence — HPTN 071 (PopART). New England Journal of Medicine, 381(3):207-218. doi:10.1056/NEJMoa1814556The original publication is available at https://www.nejm.org/BACKGROUND: A universal testing and treatment strategy is a potential approach to reduce the incidence of human immunodeficiency virus (HIV) infection, yet previous trial results are inconsistent. METHODS: In the HPTN 071 (PopART) community-randomized trial conducted from 2013 through 2018, we randomly assigned 21 communities in Zambia and South Africa (total population, approximately 1 million) to group A (combination prevention intervention with universal antiretroviral therapy [ART]), group B (the prevention intervention with ART provided according to local guidelines [universal since 2016]), or group C (standard care). The prevention intervention included home-based HIV testing delivered by community workers, who also supported linkage to HIV care and ART adherence. The primary outcome, HIV incidence between months 12 and 36, was measured in a population cohort of approximately 2000 randomly sampled adults (18 to 44 years of age) per community. Viral suppression (