title: Interventions to improve the performance of HIV health systems for treatment-as-prevention in sub-Saharan Africa:  the experimental evidence.
abstract: OBJECTIVE
  To reduce HIV incidence, treatment-as-prevention (TasP) requires high rates of HIV testing, and antiretroviral treatment (ART) uptake, retention, and adherence, which are currently not achieved in general populations in sub-Saharan Africa. We review the experimental evidence on interventions to increase these rates.
  
  
  RESULTS
  In four rapid reviews, we found nine randomized controlled trials (RCTs) on HIV-testing uptake, two on ART uptake, one on ART retention, and 15 on ART adherence in sub-Saharan Africa. Only two RCTs on HIV testing investigated an intervention in general populations; the other examined interventions in selected groups (employees, or individuals attending public-sector facilities for services). One RCT demonstrated that nurse-managed ART led to the same retention rates as physician-managed ART, but failed to show how to increase retention to the rates required for successful TasP. Although the evidence on ART adherence is strongest - several RCTs demonstrate the effectiveness of cognitive and behavioural interventions - contradictory results in different settings suggest that the precise intervention content, or the context, are crucial for effectiveness.
  
  
  CONCLUSIONS
  Future studies need to test the effectiveness of interventions to increase testing and treatment uptake, retention, and adherence under TasP, that is, ART for all HIV-infected individuals, independent of disease stage.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa. tbarnighausen@africacentre.ac.za
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control* / Q000821:virology; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents