U.S. NATIONAL INSTITUTES OF HEALTH: National Institute of Allergy and Infectious Diseases National Institute of Mental Health National Institute on Drug Abuse HPTN 071 (PopART) Population Effects of Antiretroviral Therapy to Reduce HIV Transmission IMPACT OF UNIVERSAL TESTING AND TREATMENT IN ZAMBIA AND SOUTH AFRICA: RESULTS OF A COMMUNITY-RANDOMIZED TRIAL IAS SPECIAL SESSION
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HPTN 071 (PopART) for IAS... · HPTN 071 (PopART): What have we shown? • Feasible and acceptable to deliver community-wide HIV services in urban communities with severe HIV epidemics
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U.S. NATIONAL INSTITUTES OF HEALTH:National Institute of Allergy and Infectious Diseases
National Institute of Mental HealthNational Institute on Drug Abuse
HPTN 071 (PopART)Population Effects of Antiretroviral Therapy to
Reduce HIV Transmission
IMPACT OF UNIVERSAL TESTING AND TREATMENT IN ZAMBIA AND SOUTH AFRICA:
RESULTS OF A COMMUNITY-RANDOMIZED TRIAL
IAS SPECIAL SESSION
Insufficient progress on preventionNumber of new HIV infections, global, 1990–2017 and 2020 target
Source: UNAIDS 2018 estimates.
New HIV infections Target
5 000000
4 500000
4 000000
3 500000
3 000000
2 500000
2 000000
1 500000
1 000000
500000
0
1990
1991
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2015
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2020
Nu
mb
er
of
ne
w H
IV
infe
ctio
ns
Universal testing and treatment
• All community members should test regularly for HIV and
know their status (Universal testing)
• All those diagnosed HIV-positive should be offered ART
(Universal treatment)
• Once established on ART and “virally suppressed”, risk of
transmission to partners is negligible
Undetectable = Untransmissible
PopART: What were the questions?
• Universal testing and treatment (UTT) proposed as strategy
to achieve steep reductions in HIV incidence
• Can UTT be delivered in practice in generalized epidemics
in sub-Saharan Africa?
• What impact on HIV incidence can actually be achieved?
21 Communities7 per arm (A, B & C)
12 in Zambia
9 in S Africa
Total population ~1M
Full PopART
intervention
including
immediate ART
irrespective of
CD4 count
Standard of care at current service
provision levels
including
ART initiation
according to
current national guidelines
ART initiation according to
current national guidelines
Arm A Arm B Arm C
PopART
intervention
except
Study
Design
Total estimated population of all 21 study communities 1 million