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• W2296192904 abstract "Knowledge of HIV status has increased with scale-up of HIV testing, with important contributions to access in the past few years made by non-facility community-based testing approaches. 1 Sharma M Ying R Tarr G Barnabas R Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015; 528: S77-S85 Crossref PubMed Scopus (330) Google Scholar The focus is now on linkage of individuals to appropriate services after diagnosis. Upon linkage, timely treatment is needed to achieve reductions in circulating HIV virus at the individual and population levels, for the benefit of the HIV-positive individual and to prevent transmission. 2 Cohen MS Chen YQ McCauley M et al. Prevention of HIV-1 infection with early antiretroviral therapy. The New England journal of medicine. 2011; 365: 493-505 Crossref PubMed Scopus (5408) Google Scholar , 3 INSIGHT START Study GroupInitiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015; 373: 795-807 Crossref PubMed Scopus (2) Google Scholar , 4 TEMPRANO ANRS Study GroupA trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015; 373: 808-822 Crossref PubMed Scopus (860) Google Scholar Voluntary medical male circumcision is another prevention method with proven effectiveness. 5 Auvert B Taljaard D Lagarde E Sobngwi-Tambekou J Sitta R Puren A Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005; 2: e298 Crossref PubMed Scopus (1819) Google Scholar , 6 Bailey RC Moses S Parker CB et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007; 369: 643-656 Summary Full Text Full Text PDF PubMed Scopus (1739) Google Scholar , 7 Gray RH Kigozi G Serwadda D et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007; 369: 657-666 Summary Full Text Full Text PDF PubMed Scopus (1719) Google Scholar However, coverage of either antiretroviral therapy (ART) or voluntary medical male circumcision has fallen behind targets, and new strategies are clearly needed to overcome the HIV epidemic. 8 Vermund SH Hayes RJ Combination prevention: new hope for stopping the epidemic. Curr HIV/AIDS Rep. 2013; 10: 169-186 Crossref PubMed Scopus (63) Google Scholar In The Lancet HIV, Ruanne Barnabas and colleagues 9 Barnabas RV van Rooyen H Tumwesigye E et al. Uptake of antiretroviral therapy and male circumcision after community-based HIV testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and Uganda. Lancet HIV. 2016; (published online March 9.)http://dx.doi.org/10.1016/S2352-3018(16)00020-5 Google Scholar report findings from a randomised controlled trial assessing uptake of ART and male circumcision after community-based (home and mobile) HIV testing and strategies for linkage to care in rural South Africa and Uganda. Both mobile phone text message reminders and lay counsellor follow-up visits increased uptake of circumcision for HIV negative men. Uptake of antiretroviral therapy and male circumcision after community-based HIV testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and UgandaAll the community-based strategies achieved high rates of linkage of HIV-positive people to HIV clinics, roughly a third of whom initiated ART, and of those more than 80% were virally suppressed at 9 months. Uptake of male circumcision was almost two-times higher in men who received text message reminders or lay counsellor visits than in those who received standard-of-care clinic referral. Clinic barriers to ART initiation should be addressed in future strategies to increase the proportion of HIV-positive people accessing treatment and achieving viral suppression. Full-Text PDF" @default.
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• W2296192904 title "Linkage to care: a step on the path, but not the destination" @default.
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