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

Rolland, Matthieua; McGrath, Nualab,d,e; Tiendrebeogo, Thierrya; Larmarange, Josephc,f; Pillay, Deenanc,d,g; Dabis, Françoisa; Orne-Gliemann, Joannaa for the ANRS 12249 TasP study group

doi: 10.1097/QAD.0000000000002104
Epidemiology and Social

Context: Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms.

Methods: As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 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. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.

Results: 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 vs. 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 than 1% of individual questionnaires; among men, rates varied between 5–12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24–5.45)].

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

aUniversity Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France

bAcademic Unit of Primary Care and Population Sciences and Department of Social Statistics and Demography, University of Southampton, Southampton, UK

cAfrica Health Research Institute, Somkhele, Mtubatuba

dSchool of Nursing & Public Health, University of KwaZulu-Natal, KwaZulu-Natal, South Africa

eResearch Department of Epidemiology & Public Health, University College London, London, UK

fCentre Population et Développement, Institut de Recherche pour le Développement, Université Paris Descartes, Inserm, Paris, France

gDivision of Infection and Immunity, University College London, London, UK.

Correspondence to Joanna Orne-Gliemann, University Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France. E-mail:

Received 18 April, 2018

Accepted 12 November, 2018

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