Community based approaches, key to achieving universal HIV testing – ZAMBART

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Community based approaches, key to achieving universal HIV testing – ZAMBART

Dr. Kwame Shanaube

According to ZAMBART, achieving universal HIV testing is possible but requires community based approaches rather than focusing on health facilities alone.
This was brought to light during a dissemination meeting by ZAMBART, a Zambian research organisation on the HIV Prevention Trials Network (HPTN) 071 trial, Population Effect of Universal HIV Testing and Immediate ART To Reduce HIV Transmission (PopART) Research Study conducted from 2013 to 2018.
The study conducted by HIV Prevention Trials Network (HPTN) was sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), International Initiative for Impact Evaluation (3ie), Bill and Melinda Gates Foundation, National Institutes on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH); all part of U.S National Institutes of Health (NIH).
The Centre for Infectious Disease Research in Zambia (CIDRZ) was among the PEPFAR implementing partners of the study
Professor Helen Ayles, ZAMBART Research Director, explained that the study’s aim was to find out if universal testing and treatment (UTT) could be used as a strategy to achieve steep reductions in HIV incidence;, whether UTT could be delivered in practice in generalized epidemics in Sub-Sahara Africa, and what impact on HIV incidence could be achieved.
“PoPART study used three study arms A,B and C with arm A receiving the full PoPART HIV combination prevention package (household intervention) including universal ART;, arm B received the full PoPART package but with ART only offered to those eligible in accordance with the in country guidelines, and arm C communities had no household intervention but could access HIV testing and treatment services according to in-country guidelines. PoPART interventions in arms A and B was delivered through door to door by trained lay counsellors called Community HIV -Care Providers (Chips) selected from the communities who visited every household in their zones and meet every member of their zone at least once a year to make sure they received information about HIV, tested for HIV voluntarily, provided condoms and lubricants in large quantities, screened for STIs, and TB with health facility referrals. Any body found living with HIV were referred to a health facility for treatment and referred HIV negative men for medical male circumcision” Professor Ayles explained.
The study revealed that delivery of an HIV prevention strategy that includes offering HIV testing to everyone, with immediate referral to HIV care and treatment for people living with HIV based on prevailing in-country guidelines could substantially reduce new HIV infections. Results showed that in the study arm B, where PoPART intervention included HIV treatment according to in-country guidelines, HIV incidence declined by 30 percent compared to standard of care communities in arm C. This was an improvement that was highly statistically significant.
The study also showed that in both arms A and B, the first two of the UNAIDS 90-90-90 targets were reached and high rates of viral suppression were achieved and in arm A where the PoPART intervention included the offer of universal ART even before it was national policy, HIV incidence only declined by seven percent compared to arm C.
And ZAMBART Deputy Research Director, Dr. Kwame Shanaube said, “From our findings, coverage against the first 90 target was met at 92% with 16,207 men and women out of 17664 knowing their status. Overall results indicated that the PoPART study achieved the first 90% despite gaps in men aged between 20 – 34 years and young people aged 15-17 years old. To address these gaps, we introduce alternative strategies like HIV self-testing, increased community engagement as well as repeated home visits to capture men who were not present at home. On the second 90, results show that we are close to achieving the second 90 with 88% men and 89% women among known HIV positives. However, there some gaps among young men aged between 18-34 years and women aged between 15-24 years. To improve participation, uptake of HIV testing as well as linkage to treatment, we did zonal campaigns to offer people services outside their home, assisted referrals by escorting clients to the clinics. Results further show that the second 90 was achieved in both younger male and female adolescents while gaps are evident in adult adolescents aged 15 to 19 years. Time to start ART decreased over the intervention period from a median of 10 months to three months with both men and women linking to treatment at a similar rate”.
The study concluded that community lay counsellors could gain the trust of communities and that they could enhance the uptake of HIV prevention activities. “ With adequate quality assurance systems lay counsellors can provide high quality HIV testing, provide other services like tuberculosis (TB), sexually transmitted infections (STIs) screening and referrals for voluntary medical circumcision”, added Dr. Shanaube.
Further the study concluded that achieving universal treatment was possible but requires community based approaches rather than focusing on health facilities alone and that universal treatment requires investment in community as well as facility health systems.
In addition, further recommendations were that most adolescents were HIV negative and there was need to keep them negative as well as that community lay counselors played a vital role in wider HIV prevention approaches.

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