Failure of a Universal Test-and-Treat Strategy in Rural South Africa

Achieving near-universal antiretroviral therapy (ART) coverage has been proposed to reduce HIV transmission and is the basis of the UNAIDS 90-90-90 goals. Of four population-based studies investigating if this hypothesis is true, investigators have now published one, ANRS 12249, a cluster-randomized trial in 22 communities in rural KwaZulu-Natal, South Africa, where the estimated HIV prevalence is 30%. Clusters of residents aged 16 or older were randomized to control (ART initiation according to national guidelines) or intervention (ART initiation regardless of CD4 count).

Investigators contacted 26,518 individuals (93% of those eligible), of whom 88% had HIV status ascertained and 17,808 (67%) were HIV negative on initial testing; of these,…