Cape Town – New HIV infections can be reduced by 30% through a prevention strategy that includes in-home HIV testing. This is according to the findings from the largest HIV prevention trial to date.
In-home testing, combined with referral to HIV care and treatment for people living with HIV, based on prevailing in-country guidelines, proved successful, found researchers who recently presented results from the HPTN 071 (PopART) study at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, the US.
The study examined the impact of a package of HIV prevention interventions at community-level and HIV incidence in urban and peri-urban communities in South Africa and Zambia.
The study involved more than a million people living in 21 communities.
Experts measured the effects of two HIV combination prevention strategies, offering HIV testing to people in their homes annually, with linkage to HIV care and treatment at the local health facility for those living with HIV.
In both South Africa and Zambia, hundreds of community HIV care providers went house to house over four years, with repeated offers of HIV counselling and testing.
The Desmond Tutu TB Centre (DTTC) also worked closely with the Western Cape Department of Health and the City of Cape Town health department in linking HIV-positive study participants to antiretroviral treatment at clinics.
HPTN 071 protocol chairperson and professor of epidemiology and international health at the London School of Hygiene and Tropical Medicine, Richard Hayes, said the experts saw a “highly significant” 30% decrease in new HIV infections with a prevention strategy where HIV treatment was started according to in-country guidelines.
“We did not see a similar reduction in new HIV infections with another strategy where universal HIV treatment was offered from the start of the study. Additional analyses are under way to explore the reasons for this,” Hayes said.
PopART researchers are currently examining the effects of the interventions on other study outcomes, including herpes simplex virus-2 incidence, tuberculosis and HIV-related stigma.
Work is also in progress to estimate the cost-effectiveness of the interventions.
Sarah Fidler, MBBS, PhD, protocol co-chairperson and professor of medicine at the Imperial College in London said while the findings from the PopART study were very encouraging, testing and treatment coverage fell short among young people and men, necessitating the need for further research on how to fill these important gaps.
The research team in South Africa was led by research clinicians Nulda Beyers and Peter Bock of the DTTC in the Department of Paediatrics and Child Health at Stellenbosch University.
The research team in Zambia was led by Zambian research organisation Zambart director of research Helen Ayles.
“Results from the HPTN 071 (PopART) study strongly support the ongoing expansion of the community-based platforms for health service delivery.
"There are extensive opportunities for the improved delivery of community-based health care services and more effective partnerships with communities to strengthen primary care health services in high-burden settings. Lessons learnt from PopART can be used to inform these activities,” Bock said.
Mayoral committee member for Community Services and Health Zahid Badroodien said a number of valuable lessons had been learnt from this study.
“Not only did we learn what capacity there was within health facilities to increase the number of HIV tests conducted, but it also shed light on the difficulties clients face between diagnosis and access to care.
Provincial Department of Health HIV/Aids, STI and TB director James Kruger said the study could guide authorities to tailor-make interventions.
“This will allow us to reset our provincial, district, sub-district and local planning in accordance with the outcomes and voices of the community.
"We have also learnt lessons on the deployment of community care workers and will use this to reconsider what a community health service package could be and how to add to our current services package,” Kruger said.
Beatrice Morobe, a member of the Community Advisory Board, which formed a link between the communities, the clinics and the researchers, said the study had a meaningful impact.
“It helped so many people. More people got tested for HIV and went to the clinics for treatment.”
The PopART study was sponsored by the National Institute of Allergy and Infectious Diseases with primary funding from the US President’s Emergency Plan for Aids Relief.