UNIVERSAL TEST AND CONNECT: BRIEF CONSIDERATIONS

WHAT IS UNIVERSAL TEST AND CONNECT?

Universal test and connect (UTC) is an intensive community-wide strategy to accelerate HIV epidemic transition in order to rapidly reduce new HIV infections and deaths from AIDS-related illnesses within a specific community. It is an additional, complementary strategy focused on specific communities or subnational areas, with the aim of ensuring rapid impact. UTC relies on a variety of community-based, people-centred approaches to reach people outside of healthcare facilities, connect them to quality, respectful and non-stigmatizing HIV services and transform community acceptance and engagement for HIV and health.

The evidence for UTC comes from community trials in Africa that have shown decreased HIV incidence (by approximately 20–30%) and decreased AIDS-related mortality (by approximately 20%) within three years of implementing a communitywide UTC programme, compared with current standard care. There were substantial diagnoses of people living with HIV, including men, and rates of linkage to care and treatment were high in some trials. People living with HIV who were not on treatment were identified and linked to treatment. Retention on HIV treatment (at 12 months) was extremely high, as was virologic suppression (when measured), including for people who elected same-day initiation of HIV treatment at their first clinic visit. These universal test and treat (UTT) randomized controlled trials showed that a combination of interventions can rapidly have an effect on population-level viral suppression—meeting and exceeding the 90–90–90 targets, which translate to 73% of people living with HIV being virally suppressed. Moreover, they did this by reaching and connecting substantial numbers of the people who were most likely to be missed, such as men, young people and others who do not routinely access health facilities, and people who are often not at home during routine community health worker visit hours.