HIV

HPTN071 (PopART) Population Impact of antiretroviral therapy to reduce HIV transmission

Carried out in 21 community sites (12 in Zambia and 9 in Western Cape, South Africa) in a population of approximately 1.2million, HPTNO71 (PopART) community randomised trial aims to assess the impact of a combination of HIV prevention strategies on HIV incidence over a period of three years (2014-2017).  The prevention strategies are promoted at household level by community health workers going door to door. Local government HIV services are key to implementation.  The prevention package includes HIV testing, linkage to HIV care and other services (e.g. voluntary medical male circumcision) and, in some communities, access to early HIV treatment.  A wide range of disciplines and institutions are involved in the study which is led by LSHTM and carried out in-country by Zambart and the Desmond Tutu TB Centre.  The social science component is integral to the trial planning, research, disciplinary profile and outcomes. The trial is funded by NIAID, NIMH, NIDA, PEPFAR, 3ie and the Bill & Melinda Gates Foundation.

Key project areas

  • HIV Prevention, Universal Test and Treat

Study design

Community Randomised Trial (CRT) in 21 community sites (population approx. 1.2million).  Social Science components both qualitative and quantitative and integral to design.  Disciplines include: social anthropology, social epidemiology, psychology, ethics, health economics

Countries

  • Zambia and South Africa

Dates

  • 2011-2018

Principal Investigator(s) Richard Hayes, Helen Ayles, Sarah Fidler, Nulda Beyers

Funding source

  • NIH/NIAID/BMGF/NIMH/NIDA for research, OGAC funding for implem.

Project partners

  • Zambart, Desmond Tutu TB Centre, Ministry of Health in Zambia and Provincial Health Department Western Cape South Africa, Key HIV service implementing stakeholders in Zambia and Western Cape, South Africa, FHI360, 3ie, HPTN, NIH, NIAID, BMGF, NIMH, NIDA, OGAC

Other LSHTM research staff involved

  • Richard Hayes, Helen Ayles, Janet Seeley, Sian Floyd, Kalpana Sabapathy, James Hargreaves

 

HPTN 071 Substudy: HIV-related stigma and discrimination among health workers in sub-Saharan Africa in the context of universal combination HIV prevention and treatment: a cohort

This study aims to assess the role of Universal Test and Treat in undermining and/or changing and/or increasing stigma.  The key method is a self-administered survey targeting all health workers at local health facilities and involved in the PopART trial.  Other than the survey administered three times to an open cohort (2014-2017), qualitative enquiry aims to capture the more nuanced and dynamic aspects of stigma.  Measures of stigma are also contained in a general population cohort in the main trial and this provides an opportunity to have parallel measures from different population groups within communities.  A mix of disciplines are also involved in this social science study which is led by LSTHM and carried out in-country by Zambart and the Desmond Tutu TB Centre.  The International Center for Research on Women (ICRW) in Washington is a research partner in the study which is funded by NIMH. 

Key project areas

  • HIV Stigma

Study design

  • Self-administered survey (three rounds) to open cohort of health care workers in 21 health facilities in 21 communities.  Includes qualitative component

Countries

  • Zambia and South Africa

Dates

  • 2013-2018

Principal Investigator(s)

  • James Hargreaves

Funding source

  • NIMH

Project partners

  • Zambart, Desmond Tutu TB Centre, ICRW, Ministry of Health in Zambia and Provincial Health Department Western Cape South Africa, Key HIV service implementing stakeholders in Zambia and Western Cape, South Africa, FHI360, HPTN, NIMH

Other LSHTM research staff involved

  • Shari Krishnaratne

Uptake and acceptability of HIV combination prevention package among young people in Zambia and South Africa (Adolescents in PopART)

Working within the same communities as PopART, this sub-study (2015-2017) investigates whether Universal Test and Treat is able to effectively reach young people (aged 10 to 24 years).  In the third year of the PopART intervention, adjustments have been made to tailor the intervention specifically for young people.  Qualitative research informed the design of the interventions and documents the response to interventions and how young people experience HIV in these communities over time.  The study is led by Zambart in collaboration with LSHTM and the Desmond Tutu TB Centre.  DfID funds the study as part of a regional programme (EPHSA – Regional Research and Innovation Fund). 

Key project areas

  • HIV Prevention amongst Adolescents

Study design

  • Nested within HPTN071 (PopART).  Phased design: a) Baseline studies (qualitative and quantitative), b) youth interventions, c) evaluation through cross-sectional epidemiological survey, qualitative cohort, qualitative observations.

Countries

  • Zambia and South Africa

Dates

  • 2015-2017

Principal Investigator(s)

  • Kwame Shanaube

Funding source

  • DfID through EPHSA

Project partners

  • Zambart is the grant holder. LSHTM, Desmond Tutu TB Centre, Government Ministries in Zambia, Provincial Authorities in Western Cape, South Africa, EPHSA, HPTN

Other LSHTM research staff involved

  • Richard Hayes, Helen Ayles, Sian Floyd, David Macleod

Community based distribution of oral HIV self testing: a pilot intervention and rapid impact evaluation (awaiting ethics approval)

Using community lay workers and working within four Zambian PopART community sites, this evaluation is designed as a cluster randomised trial to document the uptake of self-testing in communities exposed to intensive HIV testing and counselling interventions.  A particular interest of this study is whether self-testing is an appropriate strategy for hard to reach groups and for repeat tests amongst those who have tested HIV negative.  The study is to be carried out over a short time frame (2016-2017) and is led by Zambart in collaboration with LSHTM.  Qualitative enquiry will focus on uptake and acceptability, social harms, the social life of the oral test and local influences on testing.  The study is funded by 3ie.

Key project areas

  • HIV testing

Study design

  • Cluster Randomised Trial with a qualitative component.  Linked to four Zambian HPTN071 (PopART) sites

Countries

  • Zambia

Dates

  • 2015-2017

Principal Investigator(s)

  • Alwyn Mwinga, Helen Ayles

Funding source

  • 3IE

Project partners

  • Zambart is the grant holder. LSHTM, Ministry of Health in Zambia

Other LSHTM research staff involved

  • Constance Mackworth-Young

 

Health Transitions: Developing a comprehensive intervention to support adolescent girls living with HIV in Zambia

This short term qualitative research (2016-17) evaluates a six session support group intervention with adolescent girls living with HIV in Lusaka.  It builds on a previous study (2015-16) with adolescent girls living with HIV which focused on how they experience the transition to adulthood and identified key gaps in the support they receive.  The project will also develop sample lesson plans and topic guides for adolescents living with HIV to add to the Zambian Sexual Education curriculum in schools.  The research is led by ICRW in partnership with Zambart and funded by the MAC Foundation.

 

For more information on any of these projects please contact Virginia Bond.

 

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