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Testing and Linkage to HIV Care in China: A Cluster-Randomised Trial.

Lancet HIV 2017;4(12):e555-e565. [doi: 10.1016/S2352-3018(17)30131-5]

Zunyou Wu (Chinese Center for Disease Control and Prevention), Zhenzhu Tang (Guangxi Center of Disease Control and Prevention), Yurong Mao (Chinese Center for Disease Control and Prevention), Paul C. VanVeldhuisen (EMMES Corporation), Walter Ling (Integrated Substance Abuse Programs, UCLA), David S. Liu (National Institute on Drug Abuse), Zhiyong Shen (Guangxi Center of Disease Control and Prevention, Nanning), Roger Detels (UCLA Fielding School of Public Health), Guanghua Lan (Guangxi Center of Disease Control and Prevention, Nanning), Lynda Erinoff (National Institute on Drug Abuse), Robert Lindblad (EMMES Corporation), Diane Gu (Chinese Center for Disease Control and Prevention), Houlin Tang (Chinese Center for Disease Control and Prevention), Lian Hu (EMMES Corporation), Qiuying Zhu (Guangxi Center of Disease Control and Prevention, Nanning), Li Lu (EMMES Corporation), Neal L. Oden (EMMES Corporation), Albert L. Hasson (Integrated Substance Abuse Programs, UCLA), Yan Zhao (Chinese Center for Disease Control and Prevention), Jennifer M. McGoogan (Chinese Center for Disease Control and Prevention), Xianmin Ge (Guangxi Center of Disease Control and Prevention, Nanning), Nanci Zhang (Chinese Center for Disease Control and Prevention), Keming Rou (Chinese Center for Disease Control and Prevention), Jinhui Zhu (Guangxi Center of Disease Control and Prevention, Nanning), Hui Wei (Guangxi Zhuang Autonomous Regional Health and Family Planning Commission), Cynthia X. Shi (Chinese Center for Disease Control and Prevention), Xia Jin (Chinese Center for Disease Control and Prevention), Jian Li (Chinese Center for Disease Control and Prevention), Julio S. G. Montaner (BC Center for Excellence in HIV/AIDS).

Multistage, stepwise HIV testing and treatment procedures can result in lost opportunities to provide timely antiretroviral therapy (ART). Incomplete engagement of patients along the care cascade translates into high preventable mortality. This study aimed to identify whether a structural intervention to streamline testing and linkage to HIV health care, the "One4All" intervention, would improve testing completeness, ART initiation, and viral suppression and reduce mortality.

This cluster-randomised, controlled trial in Guangxi, China was conducted in 12 hospitals, similar in structural characteristics, past patient caseloads, and testing procedures. Hospitals were randomly assigned (1:1) to either the One4All intervention or standard of care. Hospitals were randomised in a block design and stratified by the historical rate of testing completeness of the individual hospital during the first 6 months of 2013.

A total of 478 patients were enrolled (232 in One4All, 246 in standard of care). They were aged 18 years or older who were identified as HIV-reactive during screening in study hospitals, who sought inpatient or outpatient care in a study hospital, and who resided in the study catchment area. The One4All strategy incorporated rapid, point-of-care HIV screening and CD4 counts, and in-parallel viral load testing, to promote fast and complete diagnosis and staging and provide immediate ART to eligible patients. Participants in control hospitals received standard care services. All enrolled patients were assessed for the primary outcome, which was testing completeness within 30 days, defined as completion of three required tests and their post-test counselling. Safety assessments were hospital admissions for the first 90 days and deaths up to 12 months after enrolment.

Although no difference was observed between study groups in the number of hospital admissions at 90 days, by 12 months there were 65 deaths (28%) in the in the One4All group compared with 115 (47%) in the standard-of-care group (Cox proportional hazard ratio 0.44, 0.19-1.01, p=0.0531). The One4All package of interventions also substantially increased the odds of achieving testing completeness within 30 days and ART initiation within 90 days.

Conclusions: This study provides strong evidence for the benefits of a patient-centred approach to streamlined HIV testing and treatment that could help China change the trajectory of its HIV epidemic, and help to achieve the goal of an end to AIDS. Taken together with new, strong evidence of the benefits of treating all people with HIV regardless of CD4 level, a patient-centered approach to streamline HIV testing and ART initiation regardless of CD4 count is clearly beneficial. (Article (Peer-Reviewed), PDF, English, 2017)

Keywords: CTN platform/ancillary study | HIV/AIDS | HIV rapid testing | Lancet HIV (journal)

Document No: 1282, PMID: 28867267.

Submitted by John Harris, CALIBRE Systems (9/14/2017).

AUTHORS SEARCH LINK
Detels, Roger
Erinoff, Lynda
Ge, Xianmin
Gu, Diane
Hasson, Albert L.
Hu, Lian
Jin, Xia
Lan, Guanghua
Li, Jian
Lindblad, Robert
Ling, Walter mail
Liu, David S.
Lu, Li
Mao, Yurong
McGoogan, Jennifer M.
Montaner, Julio S. G.
Oden, Neal L.
Rou, Keming
Shen, Zhiyong
Shi, Cynthia X.
Tang, Houlin
Tang, Zhenzhu
VanVeldhuisen, Paul C.
Wei, Hui
Wu, Zunyou mail
Zhang, Nanci
Zhao, Yan
Zhu, Jinhui mail
Zhu, Quiying
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Updated 11/2017 -- http://ctndisseminationlibrary.org/display/1282.htm
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