Effect of universal HIV testing and treatment on socioeconomic wellbeing in rural Kenya and Uganda: a cluster-randomised controlled trial

Abstract

Background Universal testing and treatment for HIV has shown promise as an approach to reduce mortality and lower HIV incidence. Evidence on the economic effects of this approach on individuals and households in lowresource settings is scarce. We aimed to examine the effect of universal HIV testing and treatment on a range of economic outcomes. MethodsWe collected data in household surveys done over a 3-year period in a sample of HIV-positive and HIV-negative adults participating in a cluster-randomised trial of universal HIV testing and treatment in 32 rural communities in Kenya and Uganda. Communities of approximately 10 000 people were pair-matched on the basis of geographical and population characteristics, with the best-matching 16 pairs randomly assigned (1:1) to intervention or control groups. Participants in intervention communities received annual HIV and multidisease testing, universal antiretroviral therapy (ART) eligibility, and patient-centred care. Participants in control communities received baseline testing and medical care according to national guidelines. We analysed employment and health-care utilisation outcomes for working-age adults (age 18-65 years) and education outcomes for school-age children (6-17 years) using data from 3 years after the intervention. This trial is now complete, and is registered with ClinicalTrials.gov, NCT01864603.

Intergenerational spillover effects of antiretroviral therapy in sub-Saharan Africa: a scoping review and future directions for research

“… 35 63 64 80 81 83 In a randomised controlled trial in Kenya, universal HIV testing and treatment increased primary school completion by 7% among children in households with adults diagnosed with HIV after 3 years of intervention. 81 In another Kenyan study, weekly hours of children’s school attendance increased by over 20% within 6 months after ART initiation by the adult person living with HIV. 80 Similarly, in Malawi, ART availability increased expenditures on education and schooling outcomes, including among individuals not living with HIV who did not directly benefit from ART.…”

“… 69 We identified one randomised controlled trial which examined the effect of universal HIV testing and treatment on economic outcomes of household members. 81 In figure 2 , we map the number of articles by country in SSA. Most single-country studies were from Uganda, South Africa and Kenya, whereas four studies used multicountry data.…”

“…Fifth, we identified only one randomised controlled trial. 81 More research is needed to identify potential causal spillover effects of health interventions. Future research could also identify causal mechanisms to capitalise on the positive spillover effects of treatment while mitigating potential negative spillover effects.…”

Person‐centred interventions to improve patient−provider relationships for HIV services in low‐ and middle‐income countries: a systematic review

“…From full‐text review, we identified 41 records (manuscripts or abstracts) representing 28 unique studies meeting our inclusion criteria. The SEARCH trial [ 29 ] included four unique study reports (different study populations or outcomes) [ 30 , 31 , 32 , 33 ]. The Community Score Card study had two unique study reports [ 34 , 35 ].…”

“…HIV care continuum outcomes. Eight studies included individualized counselling and patient-centred communication as the main intervention [30,31,47,49,54,[57][58][59] and six studies had a comparison group [37,40,56,58,65,66]. Among them, three studies (50%) reported that the intervention had a positive effect on at least one of the HIV care continuum outcomes reported [50,58,65] (Table 2).…”