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Universal test and treat (UTT) was evaluated in four randomized population\u2010based trials (BCPP\/Ya Tsie, HPTN 071\/PopART, SEARCH, ANRS 12249\/TasP) conducted in sub\u2010Saharan Africa\u00a0(SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90\u201090\u201090 campaign.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These three\u2010year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community\u2010based testing approaches) achieved &gt;90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient\u2010centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population\u2010level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub\u2010populations and were lower among youth. (3) UTT resulted in\u00a0marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which\u00a0mortality was comprehensively measured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These trials provide strong evidence that UTT inclusive of universal testing increases population\u2010level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub\u2010country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25455","type":"journal-article","created":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T08:06:32Z","timestamp":1582531592000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":128,"title":["What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-3136","authenticated-orcid":false,"given":"Diane","family":"Havlir","sequence":"first","affiliation":[{"name":"Department of Medicine University of California San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard School T.H. 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