Outcomes of an HIV Transmission Prevention Program in Southern Africa

A community-based program to prevent HIV transmission through universal testing and treatment achieved high rates of HIV testing and antiretroviral therapy (ART) in communities in Zambia and South Africa. These results from the HPTN 071 (PopART; ClinicalTrials.gov identifier: NCT01900977) trial were published in PLoS Medicine.¹

Although rates of new HIV infections have fallen worldwide, HIV infection is still widespread in sub-Saharan and southern Africa. In fact, rates of new HIV infections are on the rise in these regions, as the number of new HIV infections outstrips the number of deaths. Interventions for preventing HIV transmission are needed to control the epidemic and ensure that patients infected with HIV have the access they need to ART services.¹

Administering early ART in large numbers of patients with HIV has been shown to decrease HIV transmission by more than 90%. According to mathematical models, new cases of HIV infection may be markedly reduced if a significant percentage of patients with HIV are diagnosed, treated, and attain sustained viral suppression. Universal testing and treatment is expected to reduce the incidence of new HIV infections and may eventually “[eliminate] HIV as a public health problem,” the PopART investigators wrote.¹

In light of this data, the Joint United Nations Programme on HIV/AIDS (UNAIDS) proposed the 90-90-90 targets for achieving diagnosis in 90%, treatment with sustained ART in 90%, and viral suppression in 90% of individuals infected with HIV by the year 2020.² It is estimated that achieving these targets will result in a 73% viral suppression rate. However, there are many barriers to reaching the targets, including expanding HIV testing in the community and linking individuals infected with HIV to ART treatment.¹

The PopART trial examined a community-based intervention program designed to increase the rates of HIV diagnosis, treatment, and viral suppression in 21 urban communities in Zambia and South Africa, with the goal of achieving the 90-90-90 targets. The PopART intervention consisted of teams of community HIV-care providers (CHiPs) — trained lay health workers — who delivered services house-to-house that included HIV testing and counseling and referral to ART care.¹

The PopART intervention is planned to undergo 4 annual rounds. The investigators reported the results of their first annual round in 4 communities in Zambia.¹

A total of 121,130 adults were reached in the program, with 90% of women and 77% of men agreeing to participate in the intervention. A high proportion of women (85%) and men (80%) were aware of their HIV status after the home visit.¹

The CHiP teams identified 6197 adults with HIV infection and referred them for ART care. ART was initiated within 6 months in 42% of HIV-positive individuals and within 1 year of diagnosis in 53%.¹

Prior to the PopART intervention, only half of HIV-positive adults knew their HIV status, and fewer than half were treated with ART. After the intervention, up to 87% of HIV-positive adults were aware of their HIV status and approximately 60% were on ART.¹

“We have shown that after the first annual round of a community-wide household-based intervention, knowledge of HIV-positive status was close to the first 90 target in women, and approaching it in men. There was a substantial increase in the proportion of known HIV-positive individuals on ART, although the second 90 target has not yet been reached,” the investigators wrote.¹

“The repeated annual rounds of household visits are a strength of the PopART intervention, and, based on the findings of the current analysis, future rounds will focus on key challenges, including reaching men and young people and achieving more rapid linkage to care and ART initiation,” they added.¹

References

1. Hayes R, Floyd S, Schaap A, et al; HPTN 071 (PopART) Study Team. A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial. PLoS Med. 2017;14:e1002292. doi:10.1371/journal.pmed.1002292
2. Joint United Nations Programme on HIV/AIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Published 2014. Accessed May 23, 2017.