Universal test and treat strategies reduce vertical transmission of HIV

Theodore Ruel

Universal test and treat strategies implemented in communities in Uganda and Kenya more than halved HIV infection and mortality rates among infants after 3 years and reduced vertical transmission rates to 0.5% among women with known HIV, according to findings from CROI.

“The results have implications primarily for countries and public health programs,” Theodore Ruel, MD, professor of pediatrics at the University of California, San Francisco, told Healio. “Our results suggest that strategies combining population-level testing with improved patient-centered HIV care delivery models should be considered for advancing to the goal of eliminating new infections and decreasing mortality among children born to women living with HIV.”

From 2013 to 2017, Ruel and colleagues conducted population testing in 32 communities with a total population of around 350,000 and randomly assigned them to receive an intervention that included immediate ART, annual population testing and patient-centered HIV care; or HIV care according to national guidelines.

They found that, among 1,092 births to 1,042 women, the proportion of infants with HIV-free survival was higher and vertical transmission rates were lower in the intervention group compared with the control group.

By the third year, 3.3% of infants in the intervention group died or became infected with HIV (95% CI, 1.05%-6%) compared with the 6.4% in the control group (95% CI, 4.7%-8%). Vertical transmission in the intervention was 1.8% (95% CI, 0.2%-3.3%), compared with 4.4% in the control group (95% CI, 2.7%-6.1%).

Among mothers who were HIV-positive at baseline, vertical transmission occurred in 0.5% of births in the intervention arm (95% CI, 0%-1.3%) and 3.7% of births in the control arm (95% CI, 2.4%-5.1%).

“While other studies have shown the benefits of universal treatment of women prior to pregnancy, these are the first results from the major universal test and treat trials that have taken place over the last several years,” Ruel said. “We were surprised to see a major benefit from our care model for women with known infection at baseline. This suggests our model of streamlined, patient-focused care may have benefited them.”

Ruel said that for the health of women and their children, it is “prudent” to get regular testing for HIV to begin treatment early. – by Ken Downey Jr.

Reference:

Ruel T, et al. Abstract 134LB. Presented at: Conference on Retroviruses and Opportunistic Infections; March 8-11, 2020; Boston.

Disclosures: The authors report no relevant financial disclosures.