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Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.Four large-scale cluster randomized trials are ongoing in Eastern and Southern Africa to measure the efficacy of a Universal Test and Treat (UTT) approach in ‘real life’ : ANRS 12249 Tas P (Treatment–as-Prevention) in South Africa [2,3]; HPTN 071 Pop ART in South Africa and Zambia [4,5]; SEARCH in Kenya and Uganda  and the Botswana Combination Prevention project .
Triangulation of social science studies within the ANRS 12249 Tas P trial will provide comprehensive insights into the acceptability and feasibility of the Tas P intervention package at individual, community, patient and health system level, to complement the trial’s clinical and epidemiological outcomes.
It will also increase understanding of the causal impacts of UTT on social and economic outcomes, which will be critical for the long-term sustainability and routine UTT implementation.
There is limited research addressing how communities respond to participating in a research programme that involves substantial normative social change in community cultures and perceptions.
South Africans have been exposed to rapidly changing discourses from public authorities with regard to the cause of HIV/AIDS, the ways to prevent HIV infection and to care for people with HIV.
The HIV prevalence in the sub-district is one of the highest in the world, with around 29% of adults infected with HIV .
The UTT strategy being tested in the cluster-randomised Tas P trial has two main components (the trial intervention package): universal and repeat home-based HIV testing of all resident adults and immediate ART initiation.
In summary, the main hypothesis of the Tas P trial is that HIV testing of all adult members of a community, followed by immediate ART initiation of all, or nearly all, HIV-infected participants regardless of immunological or clinical staging, will prevent onward transmission and reduce HIV incidence in this population.
The Tas P trial is a cluster-randomised trial implemented in the Hlabisa sub-district, in rural northern Kwa Zulu-Natal in South Africa, an area with approximately 228 000 Zulu-speaking inhabitants.
And can UTT be implemented within capacity constraints and other threats to the overall provision of HIV services?
The answers to these research questions will be critical for routine implementation of UTT strategies.