Health-e (Cape Town)

South Africa: Study Aims to Close the HIV Tap

Photo: Carolyn Kruger/AED
Voluntary counseling and testing is used to combat HIV.

A massive population-based study launched in the Western Cape and Zambia yesterday is aiming to answer the critical question whether testing large populations for HIV and immediately starting those infected on effective antiretroviral treatment programmes, could close the tap on new infections.

The study, HPTN071 (PopART) will aim to find out whether offering a combination of several HIV prevention methods to a community will better prevent the spread of HIV that the standard individual methods currently on offer.

A five-year study, PopART will help researchers see if house-to-house voluntary HIV counseling and testing, combined with the offer of earlier antiretroviral therapy (ART) for those who test HIV-positive, can reduce the number of new HIV infections in a community.

Research has shown that the viral load of an HIV positive person is reduced significantly while on ART, reducing the likelihood of transmission when unprotected sex takes place.

“The pool of people with HIV in South Africa and sub-Saharan Africa is not getting smaller and the idea with this trial is see if we can turn off the tap (of new infections),” said Dr Peter Bock of the University of Stellenbosch’s Desmond Tutu TB Centre and one of the principal investigators.

He added that another study (HPTN052) had already confirmed modeling research, which found that the test-and-treat strategy could be the answer to stemming the epidemic, but that it had not yet been proven at population level.

Bock said the study, of which the results are expected in five years time, would look at among others the acceptance of taking treatment when people are not yet ill, the issue of adherence, the capacity of a health system to cope with such a scale-up and the cost of this intervention.

“PopART will evaluate all of these components including the qualitative factors such as stigma and treatment attitudes,” Bock explained.

The 21 communities, nine in the Western Cape and 12 in Zambia, were yesterday (SUBS: WED) randomly divided into three study arms.

Arm A communities will receive all of the HIV prevention methods via an army of community workers going door-to-door and offering HIV testing in the home. Other HIV prevention methods such as condom use and medical male circumcision will also be promoted. Those who test positive will be referred to government health facilities for ART.

Arm B communities will receive the same intervention as Arm A, but only those who meet the health department guidelines in terms of ART initiation will start their treatment.

Arm C communities will have no community workers and will receive the standard package of health care. Those prevention programmes that are identified as poor, will be strengthened.

The primary measurable outcome of the study will be the number of new HIV infections.

Professor Nulda Beyers, another principal investigator and Director of the Desmond Tutu TB Centre, said it was critical to acknowledge the willingness of the communities to participate in an effort to provide potentially lifesaving answers.

Conducted by the HIV Prevention Trials Network (HPTN), the study is led by investigators at the London School of Hygiene and Tropical Medicine, in collaboration with Imperial College London, the Zambia AIDS Related Tuberculosis (ZAMBART) project and the Desmond Tutu TB Centre at the University of Stellenbosch.

The initial phase of the study will cost in excess of U$60-million and is funded by United States government National Institutes of Health (NIH) and the Bill and Melinda Gates Foundation. – Health-e News Service

STATISTICS:

Western Cape:

· 265 000-275 000 adults living with HIV

· 13 000 new HIV infections between 2012 and 2013

· 132 000 people were on ART by December 2012

· Ante-natal survey: 18.4% of pregnant women HIV-positive with curve going up

· 196 ART sites

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