Community-wide HIV prevention strategy can reduce new infections

Photo: Kim Cloete

The study was conducted in in urban and peri-urban communities in South Africa and Zambia, and interventions included offering in-home HIV testing to everyone, with immediate referral to HIV care, and treatment for people living with HIV based on prevailing in-country guidelines.

“We saw a highly significant 30% decrease in new HIV infections with a prevention strategy where HIV treatment was started according to in-country guidelines,” said Richard Hayes, HPTN 071 protocol chair and professor of epidemiology and international health at the London School of Hygiene and Tropical Medicine. “We did not see a similar reduction in new HIV infections with another strategy where universal HIV treatment was offered from the beginning of the study. Additional analyses are underway to explore the reasons for this finding.”

The HPTN 071 (PopART) study involved more than one-million people living in 21 communities in the two countries, making it the largest HIV prevention trial to date. The study 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.

House to house

In both South Africa and Zambia, hundreds of community HIV care providers went house to house in 14 Intervention communities over a period of four years, with repeated offers of HIV counseling 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.

“Overall, both strategies improved knowledge of HIV status and uptake of treatment,” said Wafaa El-Sadr, , HPTN co-principal investigator, and professor of epidemiology and medicine at Columbia University in New York. “These findings show that a combination prevention strategy similar to PopART may be an effective tool to slow the global HIV epidemic.”

The 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.

Young people and men

“While the findings are very encouraging,” said Sarah Fidler, protocol co-chair and professor of medicine at Imperial College, London. “Testing and treatment coverage fall 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 Nulda Beyers and Peter Bock, research clinicians, Desmond Tutu TB Centre (DTTC) in the Department of Paediatrics and Child Health at Stellenbosch University. The research team in Zambia was led by Helen Ayles, director of research, Zambart, Lusaka, Zambia.

“Results from the study strongly support the ongoing expansion of the community-based platforms for health service delivery. There remain extensive opportunities for 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 going forward,” said Bock.