An extensive study on HIV prevention in Africa is underway in the Western Cape, with community workers, known as Community HIV Care Providers (CHiPs), visiting people at their homes in nine communities in and around Cape Town.
“We are very excited about this study and are watching it closely. It’s important for the future of HIV programmes not just here in South Africa, but worldwide,” said Steve Smith, the Health Attaché at the US Embassy, following a meeting with researchers from the Desmond Tutu TB Centre (DTTC), Department of Paediatrics and Child Health, at Stellenbosch University.
Aim to bring down new infections
“We need the evidence to demonstrate how to improve HIV prevention with the aim of bringing down new infections,” said Smith.
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CHiPS are visiting people in communities over a period of three and a half years for the trial – which is part of the HIV Prevention Trials Network and called HPTN 071 (The Population Effects of Antiretroviral Therapy to Reduce HIV Transmissions - PopART). The study is also being conducted in 12 communities in Zambia, led by the ZAMBART group.
Some of the study’s funders from the Office of the US Global AIDS Coordinator (OGAC), through the President’s Emergency Plan for AIDS Relief (PEPFAR) in Washington D.C. recently visited one of the Cape Town communities and were encouraged by the work done so far.
“The scope is enormous and it’s a giant undertaking, but I think they’re doing a fantastic job. We continue to be impressed by the compassion of the CHiPs and their ability to talk to people in the community about HIV and TB in a very de-stigmatised way,” said Nancy Padian, Senior Technical Advisor for PEPFAR.
Community members are provided with home-based HIV counselling and testing. They are also screened for tuberculosis and Sexually Transmitted Infections (STIs), and provided with condoms in the home. Community members are referred to the nearest local clinic for HIV care, TB treatment, STI treatment, and offered the option of medical male circumcision.
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This is a randomized controlled trial conducted in nine communities around Cape Town that are assigned to one of three arms, A, B or C. The Intervention is conducted in the three communities assigned to Arm A and three communities assigned to Arm B. In Arm A, CHiPs test people for HIV in their homes, with immediate antiretroviral therapy (ART) available in the clinic for those who test HIV positive. In Arm B, CHiPs also test people for HIV in their homes, with ART being offered in the clinics according to provincial guidelines. The three Arm C communities do not have CHiPs and health services in the clinic follow provincial guidelines.
The research component runs for four years and measures the number of new cases of HIV. Professional nurses and research enumerators carry out the research in nine communities around Cape Town.
The DTTC at Stellenbosch University is heading up the study in South Africa and is working in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) and Imperial College in London.
Blia Yang, Project Manager of the Intervention team from the DTTC said community leaders were supportive and recognized the study’s goal of striving to bring down the rate of HIV.
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“We’ve been working evenings and weekends as well as during the day to make sure we see people at their homes. It’s important to bring home the message that HIV can be prevented through a range of measures,” said Yang.
Yang also credited the Western Cape Department of Health and the City of Cape Town Health Directorate for their support. The government partners have been working alongside the DTTC to ensure that the research is carried out effectively, particularly when clients are referred for HIV treatment at its clinics.
HPTN 071 (PopART) is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), with funding from PEPFAR. Additional funding is provided by the International Initiative for Impact Evaluation, with support from the Bill & Melinda Gates Foundation, as well as by NIAID, the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), all part of the National Institutes of Health (NIH).
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Prepared by Kim Cloete for the Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University. For more information contact Kim at 082 415 0736 or firstname.lastname@example.org