Improving HIV testing and treatment in South Africa

A special issue of the journal AIDS Care has been published to coincide with the start of the 21st International AIDS conference in Durban, South Africa, including work by CPC's Nuala McGrath. The theme of the special issue is 'Universal test and treat' (UTT). UTT aims to increase uptake of HIV testing and immediate or early initiation of Antiretroviral Therapy (ART) at the population level. In this special issue, papers present new research on the psychological and socio-medical aspects of testing and treatment based on large-scale clinical trials and implementation studies in six African countries.

In the paper 'Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa' the research team investigated whether the treatment as prevention (TasP) approach could lead to better uptake of antiretroviral treatment (ART) among HIV patients. The treatment as prevention approach uses immediate ART treatment to reduce the amount of the HIV virus in a patient's bodily fluids, reducing the risk of transmission to others. The results from this study showed that participants uptake of ART was improved after intervention.

The study 'Community perceptions of repeat HIV testing' investigates the social perceptions of repeated HIV testing in communities in rural South Africa. This work involved speaking to members of the community about their perceptions of, and stigma around, repeat HIV testing and ways in which testing could be personalised and improved. The results of this study suggest there are several ways to improve the view of HIV testing within the community, including giving people the opportunity to be tested and receive ART treatment and care at home.

The paper '"It is better to die": experiences of traditional health practitioners within the HIV treatment as prevention trial communities in rural South Africa' found that the TasP approach allowed traditional healthcare practitioners to increase access to HIV testing, but that strengthening ties with communities to combat stigma is also key. The team also discovered the TasP approach could be a solution to the issue of fewer men engaging with HIV testing for fear of appearing less masculine in the community. This is detailed in the paper 'Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa'.

The research was conducted by a multi-institutional team led by Francoise Dabis (Bordeaux), Marie-Louise Newell (Southampton) and Deenan Pillay (Director of the Africa Centre for Population Health/UCL). Nuala is a co-organiser of the TasP social science team and is a member of the trial steering committee.

The special issue is available on the AIDS Care website

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