Project ACCEPT: More community-based testing and support = less HIV incidence

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Science Speaks is in Atlanta, Georgia this week and will be live-blogging from the 20th CROI — Conference on Retroviruses and Opportunistic Infections from Sunday to Wednesday, covering breaking developments from investigators on cure research, new antiretroviral agents, hepatitis, tuberculosis and treatment as prevention.

The following is a guest post by HIVMA executive director Andrea Weddle.

Scaling up of mobile community-based voluntary HIV counseling and testing and post-test support services can reduce HIV incidence at the community level, research results presented Tuesday at the 20th Conference on Retroviruses and Opportunistic Infections showed. Presenting findings from Project ACCEPT (HPTN 043), Dr. Tom Coates highlighted a 14 percent decrease in HIV incidence in communities where community-based testing was scaled up, in a National Institutes of Mental Health-supported study evaluating whether a community-level intervention could change the trajectory of the epidemic at the community level in developing countries.

The first randomized control trial of its kind included 48 communities in South Africa, Tanzania, Zimbabwe and Thailand with HIV prevalence ranging from 1 percent in a participating Thai community to 31 percent in a South African community.  Mobile community-based voluntary counseling and testing, as well as community engagement, along with post-test support was provided over a 36-month in the intervention communities. HIV incidence was in those communities was then compared to communities receiving standard facility-based testing.

During the first year, HIV testing increased by25 percent in the mobilized community. Among men a 45 percent increase was noted, while women showed a 15 percent increase (women already showed higher testing rates, likely due to routine HIV testing of pregnant women). A four-fold increase in the detection of previously undiagnosed HIV infection was reported.

Dr. Coates noted that over the course of the study, which began in 2003, significant advances in HIV prevention and treatment occurred, offering hope for an even greater impact when community-wide voluntary counseling and testing mobilization is paired with scale up of antiretroviral treatment for HIV, male circumcision and pre-exposure prevention from antiretroviral treatment.

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