ENCORE (Evaluating UTT with a National HIV Cohort to Optimize South Africa’s HIV Response)

Universal Test-and-Treat (UTT) could end the HIV epidemic if enough people start and stay on treatment. In 2016, South Africa eliminated CD4 eligibility criteria for antiretroviral therapy (ART) and, in 2017, the country moved to start patients on the same day as diagnosis. These policies were designed to increase ART coverage and have been shown to be effective in clinical trials. However, the real-world effectiveness of these UTT policies at scale is not known. Understanding the impact of UTT and at what stages of the UTT cascade patients are lost will be critical to guide the next phase of South Africa’s HIV response. For this study, we aimed to update the NHLS National HIV Cohort through the UTT era and link it with data from South Africa’s facility-based ART monitoring and evaluation system. We will use this integrated cohort to quantify losses at each stage of the UTT cascade and to assess systemwide retention and transfer in the UTT era. We will then evaluate the impact of two UTT policies – eliminating CD4 criteria and implementing same-day ART – on time from clinical presentation to ART uptake, retention, and viral suppression.