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AIDS. 2019 Jan 2. doi: 10.1097/QAD.0000000000002104. [Epub ahead of print]

No effect of test and treat on sexual behaviours at population level in rural South Africa.

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University Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France.
Academic Unit of Primary Care and Population Sciences and Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
Africa Health Research Institute, School of Nursing & Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
Research Department of Epidemiology & Public Health, University College London, London, UK.
Centre Population et Développement, Institut de Recherche pour le Développement, Université Paris Descartes, Inserm, Paris, France.
University College London, Division of Infection and Immunity, London, United Kingdom.



Within the community-randomised ANRS 12249 Treatment-as-Prevention (TasP) trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate ART irrespective of CD4 count vs CD4-guided ART (start at CD4>350 then >500) arms.


As part of the 6-monthly home-based trial rounds, a sexual behaviour questionnaire (IQ) was administered to all residents ≥16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past six months; at least one casual sexual partner in the past six months and more than one sexual partner in the past six months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. GEE models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.


CLS with regular partner varied between 29%-51% and 23%- 46% for men and women, respectively, with significantly lower odds among women in the control versus intervention arm by trial end (p < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less that 1% of IQs; among men, rates varied between 5%-12%, and odds significantly and continuously declined between calendar rounds 1 and 7 (OR = 4.2 [3.24-5.45]).


Universal Test and Treat was not associated with increased sexual risk behaviours.

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