17 Jul HIV Incidence: Effect of Universal Testing and Treatment
MedicalResearch.com Interview with:
Dr. Richard J. Hayes, DSc, FMedSci
Professor of Epidemiology and International Health
London School of Hygiene and Tropical Medicine
MedicalResearch.com: What is the background for this study?
Response: HIV incidence rates remain at very high levels in many parts of southern Africa. Universal testing and treatment (i.e., ensuring that everyone in a community tests for HIV and that everyone diagnosed with HIV is started on treatment as soon as possible) has been proposed as a strategy to achieve steep reductions in HIV incidence in generalized epidemics. Prior trials have shown inconsistent results as to whether this strategy could be effective.
HPTN 071 (PopART) was carried out in 21 urban communities in Zambia and South Africa, with individual communities randomly assigned into one of three arms: A, B or C. The 14 communities in Arms A and B received annual rounds of home-based HIV testing by community health workers who supported linkage to care, antiretroviral therapy (ART) adherence and other HIV services. The seven communities in Arm C received the local standard of care. We looked to see if the HIV incidence in the communities receiving universal testing and treatment would be lower (over time) compared to the incidence in the standard of care communities.
MedicalResearch.com: What are the main findings?
Response: HPTN 071 (PopART) showed a highly significant 30 percent decrease in new HIV infections with a prevention strategy where HIV treatment was started, according to in-country guidelines (i.e., Arm B). We did not see a similar reduction in new HIV infections when universal HIV treatment was offered from the beginning of the study (i.e., Arm A). This difference in results between Arms A and B was unexpected, and additional analyses are underway to explore the reasons for this finding.
Since the interventions in Arms A and B were very similar through much of the trial period and achieved similar treatment coverage, we completed a post hoc analysis that combined Arms A and B and compared incidence to the standard of care arm. The analysis showed a significant decrease – approximately 20 percent – in new HIV infections.
MedicalResearch.com: What should readers take away from your report?
Response: Delivery of an HIV prevention strategy that includes offering in-home HIV testing to everyone, with immediate referral to HIV care, and rapid initiation of treatment for people living with HIV, can substantially reduce new HIV infections. Our findings show a combination prevention strategy like PopART may be an effective tool to slow the global HIV epidemic.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We are already pursuing several research projects to extend what we’ve learned in HPTN 071 (PopART). For example, a new study in Zambia is evaluating a peer-led program to improve uptake of HIV testing and sexual and reproductive health services among adolescents and young people.
Richard J. Hayes, D.Sc., F.Med.Sci., Deborah Donnell, Ph.D., Sian Floyd, M.Sc., Nomtha Mandla, M.P.H., Justin Bwalya, B.Sc., R.N., Kalpana Sabapathy, M.B., B.S., M.R.C.P., Ph.D., Blia Yang, B.Sc.,Mwelwa Phiri, B.Pharm., M.P.H., Ab Schaap, M.Sc., Susan H. Eshleman, M.D., Ph.D., Estelle Piwowar-Manning, B.S., M.T. (ASCP), Barry Kosloff, M.Sc.,Anelet James, M.Sc., Timothy Skalland, Ph.D., Ethan Wilson, M.S., Lynda Emel, Ph.D., David Macleod, Ph.D.,Rory Dunbar, Ph.D., Musonda Simwinga, Ph.D., NozizweMakola, B.Ed., P.G.Dip. (App. Ethics), P.G.Dip. (HIV Manag.), Virginia Bond, Ph.D.,Graeme Hoddinott, Ph.D.,Ayana Moore, Ph.D., Sam Griffith, M.A.T., Nirupama Deshmane Sista, Ph.D., Sten H. Vermund, M.D., Ph.D., Wafaa El-Sadr, M.D., M.P.H., David N. Burns, M.D., M.P.H., James R. Hargreaves, Ph.D., Katharina Hauck, Ph.D., Christophe Fraser, Ph.D., Kwame Shanaube, M.D., Ph.D., Peter Bock, Ph.D., M.R.C.P., M.P.H., Nulda Beyers, M.B., Ch.B., Ph.D., Helen Ayles, M.B., B.S., M.R.C.P., Ph.D., and Sarah Fidler, M.B., B.S., Ph.D. for the HPTN 071 (PopART) Study Team
N Engl J Med 2019; 381:207-218
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