PopART study to test impact of combo HIV prevention strategy

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Professor Richard Hayes of the London School of Hygiene & Tropical Medicine (LHSTM) will lead a team of researchers in a $37 million project – entitled PopART – to test innovative combination strategies to prevent HIV in African countries. That’s according to a press release from LSHTM last week that announced the joint effort to fund the multimillion dollar study by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the Office of the U.S. Global AIDS Coordinator and the Bill & Melinda Gates Foundation.

Testing the mantra that there is “no silver bullet” in HIV prevention, the study will assess the impact of offering the following three interventions: community-wide, house-to-house voluntary testing for HIV; an offer of voluntary medical male circumcision to men who test HIV-negative; and an offer of immediate initiation of antiretroviral therapy (ART) for all of those who test HIV-positive. Mathematical modeling has suggested that this combination approach will lead to a steep reduction in new HIV infections and will prove cost-effective over time, and study authors will use this opportunity to determine whether such a strategy can be deployed successfully in resource-limited settings in Africa and what the population-level impact will be.

Twenty-four communities in Zambia and South Africa will participate in the study – a combined population of more than 1 million people – starting in 2012. The study will have three arms:
·         Eight communities will receive the full PopART intervention
·         Eight control communities will receive current standard of care
·         Eight communities will receive an intermediate intervention that includes all PopART components, except that ART will be given according to current national guidelines.

“This three-arm design will allow the trial to measure the extra effect of treating patients immediately rather than waiting until their immune function has deteriorated,” according to the LHSTM press release. “A total of 60,000 adults from the communities will be followed up for 2 years to measure the impact of the interventions on new HIV infections.”

The PopART study is funded through the HIV Prevention Trials Network (HPTN) and builds upon two previous network trials: HPTN 052, which recently demonstrated that early initiation of an HIV positive person on ART prevented the spread of infection to their HIV-negative sexual partner by more than 96 percent as compared to those who delayed treatment; and Project Accept (HPTN 043), which “found that adding community mobilization and support services to a mobile HIV counseling and testing program can improve rates of testing in rural communities,” according to the press release. PopART is a collaboration among researchers from LSHTM, the Imperial College London, The Zambia AIDS Related Tuberculosis Project, and the Desmond Tutu TB Centre at Stellenbosch University in South Africa.

There are an estimated 33 million people living with HIV around the world, with 2.5 new infections matching every person starting ART. According to the press release, “Combination prevention approaches like PopART may be initially more expensive than current approaches, but estimates suggest that if HIV incidence is not reduced significantly, the financial impact of an ever increasing number of patients in need of treatment and hospitalization will be far greater.”

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