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Historic research to reduce HIV transmission

Wednesday, 06 February 2013

Twenty one communities in South Africa and Zambia will be part of a six-year research study to test the impact of a combined package of several HIV prevention interventions on population-level HIV incidence.

The study HPTN 071, also known as PopART (Population Effects of Antiretroviral Therapy to reduce HIV Transmission), will investigate whether providing a combination of HIV treatment and prevention interventions to communities will better prevent the spread of HIV than the standard methods that are offered today.

Researchers will carry out the study in established research sites in areas known to have a high HIV prevalence and incidence. Twelve targeted communities across three provinces in Zambia and nine in the Western Cape, South Africa, have been randomly assigned to one of three different programmes of care.

The rigorously designed study is the most intense ever to be  conducted into HIV prevention in Southern Africa and will be done by the Desmond Tutu TB Centre (DTTC) at Stellenbosch University and the ZAMBART project in Zambia in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM), and Imperial College, London.

HPTN 071 will help researchers determine how well house-to-house voluntary testing and immediate treatment, called the “Treatment as Prevention” approach can work on a large community scale, and whether it is possible and affordable to deliver.

“We are not coming to terms with this epidemic. At the moment, for every one person on treatment there are two new infections. We need a complete re-think of the way we deliver prevention and care,” said Dr Helen Ayles, Project Coordinator for ZAMBART.

The study, with an expected research budget of more than US$60million is funded through the HIV Prevention Trials Network (HPTN), by the Office of the United States Global AIDS Coordinator (OGAC), the Bill and Melinda Gates Foundation, National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and National Institute of Health, National Institutes on Drug Abuse. The study will be carried out in communities with a total population of approximately 1 million people.

PopART is one of many HIV prevention studies being conducted by the HPTN in Southern Africa, a region with the highest HIV incidence in sub-Saharan Africa and in need of more effective prevention measures.

“PopART will make it possible for universities, departments of health, non-governmental organisations and communities to work together to find novel ways of reducing the transmission of HIV - and we hope it will result in better health for our people," said Professor Nulda Beyers,  Director of the Desmond Tutu TB Centre (DTTC) at Stellenbosch University.

Each of the selected communities will be randomly allocated into three different groups and receive different intervention services. The three different study groups will be replicated in each country and the rate of new HIV infections will be compared between these groups at the end of the research.

One group of communities will receive house-to-house voluntary HIV counseling and testing with the offer of immediate ART to all individuals who test positive, together with other prevention methods. These prevention methods include promotion of male medical circumcision, and prevention of mother to child transmission for pregnant women with HIV, referral to care for individuals with sexually transmitted infections, and distribution of condoms.

The second group of communities will receive all of the HIV prevention methods in the study, but HIV treatment will only be offered to those eligible according to respective national guidelines.

For the third group of communities, no new healthcare interventions will be introduced other than the current standard of health care services offered in each country. However, the research team will endeavour to ensure that all standard health services are present and available.

“The PopART study will strictly follow guidelines and procedures that won’t violate rights or confidentiality of persons volunteering to be involved in the trial,” said Dr Ayles.

The study has been supported by the Ministry of Health, and Ministry of Community Development, Mother and Child Health in Zambia, the Cape Town City Health Directorate and Western Cape Government Department of Health in South Africa.

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