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Randomized Controlled Trial
. 2014 Feb 13:15:57.
doi: 10.1186/1745-6215-15-57.

HPTN 071 (PopART): rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment - a study protocol for a cluster randomised trial

Richard Hayes, Helen Ayles, Nulda Beyers, Kalpana Sabapathy  1 , Sian Floyd, Kwame Shanaube, Peter Bock, Sam Griffith, Ayana Moore, Deborah Watson-Jones, Christophe Fraser, Sten H Vermund, Sarah Fidler; HPTN 071 (PopART) Study Team
Affiliations
Randomized Controlled Trial

HPTN 071 (PopART): rationale and design of a cluster-randomised trial of the population impact of an HIV combination prevention intervention including universal testing and treatment - a study protocol for a cluster randomised trial

Richard Hayes et al. Trials. .

Abstract

Background: Effective interventions to reduce HIV incidence in sub-Saharan Africa are urgently needed. Mathematical modelling and the HIV Prevention Trials Network (HPTN) 052 trial results suggest that universal HIV testing combined with immediate antiretroviral treatment (ART) should substantially reduce incidence and may eliminate HIV as a public health problem. We describe the rationale and design of a trial to evaluate this hypothesis.

Methods/design: A rigorously-designed trial of universal testing and treatment (UTT) interventions is needed because: i) it is unknown whether these interventions can be delivered to scale with adequate uptake; ii) there are many uncertainties in the models such that the population-level impact of these interventions is unknown; and ii) there are potential adverse effects including sexual risk disinhibition, HIV-related stigma, over-burdening of health systems, poor adherence, toxicity, and drug resistance.In the HPTN 071 (PopART) trial, 21 communities in Zambia and South Africa (total population 1.2 m) will be randomly allocated to three arms. Arm A will receive the full PopART combination HIV prevention package including annual home-based HIV testing, promotion of medical male circumcision for HIV-negative men, and offer of immediate ART for those testing HIV-positive; Arm B will receive the full package except that ART initiation will follow current national guidelines; Arm C will receive standard of care. A Population Cohort of 2,500 adults will be randomly selected in each community and followed for 3 years to measure the primary outcome of HIV incidence. Based on model projections, the trial will be well-powered to detect predicted effects on HIV incidence and secondary outcomes.

Discussion: Trial results, combined with modelling and cost data, will provide short-term and long-term estimates of cost-effectiveness of UTT interventions. Importantly, the three-arm design will enable assessment of how much could be achieved by optimal delivery of current policies and the costs and benefits of extending this to UTT.

Trial registration: ClinicalTrials.gov NCT01900977.

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Figures

Figure 1
Figure 1
Summary of trial design.
Figure 2
Figure 2
Map showing location of study communities.
See this image and copyright information in PMC

References

    1. UNAIDS. Global Report: UNAIDS Report on the Global AIDS Epidemic. 2012. [ http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo...] Accessed 30 October 2013.
    1. Hankins CA, de Zalduondo BO. Combination prevention: a deeper understanding of effective HIV prevention. AIDS. 2010;24(Suppl 4):S70–S80. doi: 10.1097/01.aids.0000390709.04255.fd. - DOI - PubMed
    1. Pirrone V, Thakkar N, Jacobson JM, Wigdahl B, Krebs FC. Combinatorial approaches to the prevention and treatment of HIV-1 infection. Antimicrob Agents Chemother. 2011;55(5):1831–1842. doi: 10.1128/AAC.00976-10. - DOI - PMC - PubMed
    1. Templeton DJ. Male circumcision to reduce sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):344–349. doi: 10.1097/COH.0b013e32833a46d3. - DOI - PubMed
    1. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298. doi: 10.1371/journal.pmed.0020298. - DOI - PMC - PubMed

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