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BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Study protocol

Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal

Authors: Joanna Orne-Gliemann, Joseph Larmarange, Sylvie Boyer, Collins Iwuji, Nuala McGrath, Till Bärnighausen, Thembelile Zuma, Rosemary Dray-Spira, Bruno Spire, Tamsen Rochat, France Lert, John Imrie, for the ANRS 12249 TasP Group

Published in: BMC Public Health | Issue 1/2015

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Abstract

Background

The Universal HIV Test and Treat (UTT) strategy represents a challenge for science, but is also a challenge for individuals and societies. Are repeated offers of provider-initiated HIV testing and immediate antiretroviral therapy (ART) socially-acceptable and can these become normalized over time? Can UTT be implemented without potentially adding to individual and community stigma, or threatening individual rights? What are the social, cultural and economic implications of UTT for households and communities? And can UTT be implemented within capacity constraints and other threats to the overall provision of HIV services? The answers to these research questions will be critical for routine implementation of UTT strategies.

Methods/design

A social science research programme is nested within the ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomised trial in rural South Africa. The programme aims to inform understanding of the (i) social, economic and environmental factors affecting uptake of services at each step of the continuum of HIV prevention, treatment and care and (ii) the causal impacts of the TasP intervention package on social and economic factors at the individual, household, community and health system level. We describe a multidisciplinary, multi-level, mixed-method research protocol that includes individual, household, community and clinic surveys, and combines quantitative and qualitative methods.

Discussion

The UTT strategy is changing the overall approach to HIV prevention, treatment and care, and substantial social consequences may be anticipated, such as changes in social representations of HIV transmission, prevention, HIV testing and ART use, as well as changes in individual perceptions and behaviours in terms of uptake and frequency of HIV testing and ART initiation at high CD4. Triangulation of social science studies within the ANRS 12249 TasP trial will provide comprehensive insights into the acceptability and feasibility of the TasP intervention package at individual, community, patient and health system level, to complement the trial’s clinical and epidemiological outcomes. It will also increase understanding of the causal impacts of UTT on social and economic outcomes, which will be critical for the long-term sustainability and routine UTT implementation.

Trial registration

Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.
Appendix
Available only for authorised users
Literature
1.
AVAC. Antiretroviral treatment for prevention of HIV and tuberculosis: 2013 update on current and planned research efforts. New York: AVAC; 2014. p. 64.
2.
Iwuji CC, Orne-Gliemann J, Tanser F, Boyer S, Lessells RJ, Lert F, et al. Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial. Trials. 2013;14:230.CrossRefPubMedPubMedCentral
3.
4.
5.
Hayes R, Ayles H, Beyers N, Sabapathy K, Floyd S, Shanaube K, et al. HPTN 071 (PopART): Rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment – a study protocol for a cluster randomised trial. Trials. 2014;15:57.CrossRefPubMedPubMedCentral
6.
7.
8.
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373:48–57.CrossRefPubMed
9.
Hontelez JAC, Lurie MN, Bärnighausen T, Bakker R, Baltussen R, Tanser F, et al. Elimination of HIV in South Africa through expanded access to antiretroviral therapy: a model comparison study. PLoS Med. 2013;10:e1001534.CrossRefPubMedPubMedCentral
10.
Eaton JW, Johnson LF, Salomon JA, Bärnighausen T, Bendavid E, Bershteyn A, et al. HIV Treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med. 2012;9:e1001245.CrossRefPubMedPubMedCentral
11.
Sabapathy K, Van den Bergh R, Fidler S, Hayes R, Ford N. Uptake of home-based voluntary HIV testing in Sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2012;9:e1001351.CrossRefPubMedPubMedCentral
12.
Obare F, Fleming P, Anglewicz P, Thornton R, Martinson F, Kapatuka A, et al. Acceptance of repeat population-based voluntary counselling and testing for HIV in rural Malawi. Sex Transm Infect. 2009;85:139–44.CrossRefPubMed
13.
Helleringer S, Mkandawire J, Reniers G, Kalilani-Phiri L, Kohler HP. Should home-based HIV testing and counseling services be offered periodically in programs of ARV treatment as prevention? A Case Study in Likoma (Malawi). AIDS Behav. 2013;17(6):2100–8.CrossRefPubMedPubMedCentral
14.
Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, et al. Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis. Trop Med Int Health. 2012;17(12):1509–20.CrossRefPubMedPubMedCentral
15.
World Health Organisation. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a Public Health Approach. Geneva: WHO; 2013.
16.
Southern African HIV Clinicians Society. Statement on WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Johannesburg: SAHIVSOC; 2013.
17.
Bärnighausen T, Tanser F, Dabis F, Newell M-L. Interventions to improve the performance of HIV health systems for treatment-as-prevention in sub-Saharan Africa: the experimental evidence. Curr Opin HIV AIDS. 2012;7:140–50.CrossRefPubMed
18.
Zuma T, Newell M-L, Maphumulo K, Imrie J, Dabis F. Testing gives us a chance to get encouraged and say let us stand up…then we will get help’: Contrasting Community Representations of HIV Testing in the Context of Treatment as Prevention (Tasp) in Rural North-Eastern KwaZulu-Nata. Durban: 5th South Afr AIDS Conf; 2011. 7-10 June 2011. PS1-183 241.
19.
Zuma T, Maphumulo K, Newell M-L, Dabis F, Imrie J. Treatment as Prevention (TasP) Preparatory Study Report - Ukuphila Kwami, Ukuphila Kwethu - My Health for Our Health. Somkhele: Africa Centre for Health and Population Studies; 2012.
20.
Bond V, Hoddinott G, Simuyaba M, Abrahams K, Ayles H, Beyers N, et al. “What is this ‘Universal Test and Treat’ (UTT)?” Community understandings of key concepts linked to a combination HIV prevention strategy in 21 Zambian and South African communities. Melbourne: Oral communication n°WEAC0103 at 20th International AIDS Conference; 2014.
21.
Zaidi J, Grapsa E, Tanser F, Newell M-L, Bärnighausen T. Dramatic increase in HIV prevalence after scale-up of antiretroviral treatment. AIDS. 2013;27:2301–5.CrossRefPubMedPubMedCentral
22.
Iwuji C, Orne-Gliemann J, Tanser F, Thiébaut R, Larmarange J, Okesola N, et al. Feasibility and acceptability of an antiretroviral treatment as prevention (TasP) intervention in rural South Africa: results from the ANRS 12249 TasP cluster-randomised trial. Melbourne: Oral communication n°WEAC0105LB at 20th International AIDS Conference; 2014.
23.
Hull MW, Wu Z, Montaner JSG. Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention. Curr Opin HIV AIDS. 2012;7:579–86.CrossRefPubMed
24.
Coates TJ, Kulich M, Celentano DD, Zelaya CE, Chariyalertsak S, Chingono A, et al. Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Glob Health. 2014;2:e267–77.CrossRefPubMedPubMedCentral
25.
Imrie J, Tanser F. Targeting strategies and behavior change to combat the HIV epidemic in southern Africa. Future Virol. 2011;6:793–800.CrossRef
26.
Van Rooyen H, Barnabas RV, Baeten JM, Phakathi Z, Joseph P, Krows M, et al. High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2013;64(1):e1–8. Sep 1.CrossRefPubMedPubMedCentral
27.
Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review. AIDS. 2012;26:2059–67.CrossRefPubMed
28.
Anglaret X, Minga A, Gabillard D, Ouassa T, Messou E, Morris B, et al. AIDS and Non-AIDS morbidity and mortality across the spectrum of CD4 cell counts in HIV-infected adults before starting antiretroviral therapy in Côte d’Ivoire. Clin Infect Dis. 2012;54:714–23.CrossRefPubMed
29.
Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14:281–90.CrossRefPubMedPubMedCentral
30.
McGrath N, Eaton JW, Bärnighausen TW, Tanser F, Newell M-L. Sexual behaviour in a rural high HIV prevalence South African community: time trends in the antiretroviral treatment era. AIDS. 2013;27(15):2461–70. Sep 24.CrossRefPubMedPubMedCentral
31.
Jean K, Gabillard D, Moh R, Danel C, Fassassi R, Desgrées Du Loû A, et al. Effect of early antiretroviral therapy on sexual behaviors and HIV-1 transmission risk among adults with diverse heterosexual partnership statuses in Cote d’Ivoire. J Infect Dis. 2013;17:18977. Jun 30.
32.
McGrath N, Grapsa E, Newell M-L. Does ART contribute to behaviour change? : Partnership change and sexual behaviour among attenders of a public HIV treatment and care programme in rural KwaZulu-Natal, South Africa. Melbourne: 20th Int AIDS Conf; 2014. July 20-25, 2014. [Abstract n°TUPE162].
33.
Bor J, Tanser F, Newell M-L, Bärnighausen T. In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment. Health Aff Proj Hope. 2012;31:1459–69.CrossRef
34.
35.
Rowe AK, de Savigny D, Lanata CF, Victora CG. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet. 2005;366:1026–35.CrossRefPubMed
36.
Tanser F, Hosegood V, Barnighausen T, Herbst K, Nyirenda M, Muhwava W, et al. Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol. 2008;37:956–62.CrossRefPubMed
37.
Cleary S, Birch S, Chimbindi N, Silal S, McIntyre D. Investigating the affordability of key health services in South Africa. Soc Sci Med. 2013;80:37–46.CrossRefPubMed
38.
Rabin R, De CF. EQ-SD: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.CrossRefPubMed
39.
40.
Chimbindi N, Bärnighausen T, Newell M-L. Patient satisfaction with HIV and TB treatment in a public programme in rural KwaZulu-Natal: evidence from patient-exit interviews. BMC Health Serv Res. 2014;14:32.CrossRefPubMedPubMedCentral
41.
Yeji F, Klipstein-Grobusch K, Newell M-L, Hirschhorn LR, Hosegood V, Bärnighausen T. Are social support and HIV coping strategies associated with lower depression in adults on antiretroviral treatment? Evidence from rural KwaZulu-Natal, South Africa. AIDS Care. 2014;0:1–8.
42.
Kim J, Han JY, Shaw B, McTavish F, Gustafson D. The roles of social support and coping strategies in predicting breast cancer patients’ emotional well-being testing mediation and moderation models. J Health Psychol. 2010;15:543–52.CrossRefPubMedPubMedCentral
43.
García-Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts C. WHO Multi-Country Study on Women’s Health and Domestic Violence against Women: Initial Results on Prevalence, Health Outcomes and Women’s Responses. Geneva: World Health Organization; 2005.
44.
Chaiyachati K, Hirschhorn LR, Tanser F, Newell M-L, Bärnighausen T. Validating five questions of antiretroviral nonadherence in a public-sector treatment program in rural South Africa. AIDS Patient Care STDs. 2011;25:163–70.PubMedPubMedCentral
45.
Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical trials group (AACTG). AIDS Care. 2000;12:255–66.CrossRefPubMed
46.
Carrieri P, Cailleton V, Le Moing V, Spire B, Dellamonica P, Bouvet E, et al. The dynamic of adherence to highly active antiretroviral therapy: results from the French National APROCO cohort. J Acquir Immune Defic Syndr. 2001;28:232–9.CrossRefPubMed
47.
Spire B, Carrieri P, Sopha P, Protopopescu C, Prak N, Quillet C, et al. Adherence to antiretroviral therapy in patients enrolled in a comprehensive care program in Cambodia: a 24-month follow-up assessment. Antivir Ther. 2008;13:697–703.PubMed
48.
Boyer S, Clerc I, Bonono C-R, Marcellin F, Bilé P-C, Ventelou B. Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: Individual and healthcare supply-related factors. Soc Sci Med. 2011;72:1383–92.CrossRefPubMed
49.
Oyugi JH, Byakika-Tusiime J, Ragland K, Laeyendecker O, Mugerwa R, Kityo C, et al. Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda. AIDS Lond Engl. 2007;21:965–71.CrossRef
50.
Holzemer WL, Uys LR, Chirwa ML, Greeff M, Makoae LN, Kohi TW, et al. Validation of the HIV/AIDS Stigma Instrument - PLWA (HASI-P). AIDS Care. 2007;19:1002–12.CrossRefPubMed
51.
Kroenke K, Spitzer RL, Williams JBW, Löwe B. An Ultra-brief screening scale for anxiety and depression: the PHQ–4. Psychosomatics. 2009;50:613–21.PubMed
52.
Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122:86–95.CrossRefPubMed
53.
Spitzer RL, Kroenke K, Williams JW, and the Patient Health Questionnaire Primary Care Study Group. Validation and utility of a self-report version of prime-md: The phq primary care study. JAMA. 1999;282:1737–44.CrossRefPubMed
54.
55.
Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the patient health questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22:1596–602.CrossRefPubMedPubMedCentral
56.
Duračinský M, Lalanne C, Acquadro C, Hermann S, Lau J, Lecoeur S, et al. Psychometric validation of PROQOL-HIV a contemporaneous and cross-cultural health-related quality-of-life (HRQL) questionnaire specific to HIV. Cape Town: 5th IAS Conf HIV Pathog Treat Prev; 2009 [Abstract n°WEPED180]
57.
Theis J, Grady HM. Participatory Rapid Appraisal for Community Development: A Training Manual Based on Experiences in the Middle East and North Africa. London, UK: International Institute for Environment and Development : Save the Children Federation; 1991.
58.
Souville M, Msellati P, Carrieri M-P, Brou H, Tape G, Dakoury G, et al. Physicians’ knowledge and attitudes toward HIV care in the context of the UNAIDS/Ministry of Health Drug Access Initiative in Côte d’Ivoire. AIDS Lond Engl. 2003;17 Suppl 3:S79–86.CrossRef
59.
Wilson D, Taaffe J, Fraser-Hurt N, Gorgens M. The economics, financing and implementation of HIV treatment as prevention: What will it take to get there? Afr J AIDS Res. 2014;13:109–19.CrossRefPubMed
Metadata
Title
Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal
Authors
Joanna Orne-Gliemann
Joseph Larmarange
Sylvie Boyer
Collins Iwuji
Nuala McGrath
Till Bärnighausen
Thembelile Zuma
Rosemary Dray-Spira
Bruno Spire
Tamsen Rochat
France Lert
John Imrie
for the ANRS 12249 TasP Group
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1344-y

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