South Africa: World's Largest HIV Prevention Trial Wraps Up Door-to-Door Testing

1 December 2017

Cape Town — One of the crucial aspects of the largest HIV prevention trial in the world is nearing an end, with HIV counsellors wrapping up four years of door-to-door visits to many thousands of homes in and around Cape Town and the Winelands region.

Over the past four years, 270 fieldworkers, known as the Community HIV Care Providers (CHiPS) have been door to door in the Western Cape as part of the Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (HPTN 071 (PopART) trial. They complete their work in December.

The HPTN 071 (PopART) study has involved about one million people across 21 communities in the Western Cape and Zambia. It was set up to determine the impact of a package of HIV prevention strategies on the transmission of HIV in communities.

CHiPS, also known as HIV counsellors, offer HIV testing and counseling in people’s homes and actively refer HIV-positive clients to Department of Health clinics for HIV care and Antiretroviral (ARV) treatment.  They provide condoms, test people for tuberculosis (TB), screen people for sexually transmitted infections and do the necessary referrals care and treatment for antenatal care, family planning and voluntary Medical Male Circumcision.

The CHiPS have been widely recognized for the care, counseling and support they have shown to people across communities since the beginning of 2014.

“They have been at the forefront of the HIV epidemic by going door-to-door to test people in the community for HIV. We applaud them for the tremendous work they have done,” said Blia Yang, Intervention Manager for the HPTN 071/PopART study in South Africa, which is based at the Desmond Tutu TB Centre (DTTC) at Stellenbosch University.

PopART has been a collaboration between the DTTC, the communities in which they work, the Western Cape and City of Cape Town Health Departments and implementing partners, ANOVA, Kheth’Impilo and the South African Clothing and Textile Workers Union.

This collaboration has ensured that clients get the treatment they need. Clinics connected to the trial have stepped up services to help cope with the higher number of people going to the clinics for HIV care and ARVs due to the PopART work in the communities.

“Four years in the community was possible only due to their collaboration and support to end HIV,” said Yang.

Tracey Naledi, Chief Director of Health Programmes for the Western Cape Department of Health, said the province had learnt valuable lessons from the trial.

“We have learnt so much from what has come out of the implementation of the research study. We have learnt how to reach men better. We’ve learnt how to do community testing, and we are committing that as far as it is possible, the lessons that have come out of this process, we will incorporate in our daily business.”

Karen Jennings Head HIV/STI/TB in the City of Cape Town’s Department of Health, said the PopART study had enabled CHiPS and clinic staff to “share the responsibility of caring for thousands of community members.”

“The PopART study has also increased knowledge and skills and increased access to health services.”

Some of the HIV counsellors composed a poem about their experience in the community. They expressed how bringing HIV testing to people’s homes had changed people’s lives.  They talked about encouraging and supporting people who were HIV positive to get and stay on ARVs.

“We have lost friends and family because of you, HIV and TB. But now, HIV and TB, you are losing, we are winning. We have tried to conquer you by bringing PopART to our communities.  People trust us with their lives. We say encouraging words to them. We are winning, you are losing, HIV. We can live a positive and peaceful life without fear of you, HIV, because of you, ARVs.”

Men, especially those who work, do not usually go to clinics and therefore are often not tested for HIV, but Yang said fieldworkers had worked after hours and during weekends in a successful bid to test more men for HIV.

The work done by the CHiPs workers in communities has been funded by the US Centers for Disease Control and Prevention (CDC) through the President’s Emergency Plan for AIDS Relief (PEPFAR) – the US government’s investment in the HIV response in South Africa.

“Our mission is to bring an end to the dual epidemic of HIV and TB. PopART is a crucial piece of the science that implementers are looking forward to receiving to help us chart the way forward. It is precisely the type of innovation we need to work for an AIDS-free generation to become a reality,” said Dr Amy Herman-Roloff, CDC South Africa Country Director.

The Desmond Tutu TB Centre (DTTC) at Stellenbosch University has been heading up the trial in South Africa, with ZAMBART as its counterpart in Zambia, and the London School of Hygiene and Tropical Medicine, Imperial College and HPTN as research partners.  Research aspects of the trial will continue into 2018. The key findings of the HPTN 071 (PopART) study will be released in 2019.

CDC has estimated that there were 270,000 new HIV infections and 110,000 HIV-related deaths in South Africa in 2016.

“A sense of urgency is going to be critical to our next steps. We estimate that 7.1 million people are living with HIV in South Africa. South Africa has the largest HIV treatment programme in the world, yet only just over half of those living with HIV are on antiretroviral treatment,” said Herman-Roloff.

Research has shown that starting ARVs earlier has proved to keep people healthier longer by cutting the risk of serious illness or death by 53%.  It also cuts the risk of developing AIDS by 70 percent and lowers the risk of passing HIV to a sexual partner by 96%.

Kim Cloete wrote this article on behalf of the Desmond Tutu TB Centre in the Department of Paediatrics and Child Health at Stellenbosch University.

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