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Dynamic Partnerships Across Community, Academic and Policy Sectors: HPTN 071 The PopART Study

Dynamic Partnerships Across Community, Academic and Policy Sectors: HPTN 071 The PopART Study. Helen Ayles, on behalf of the HPTN071 study team. Hypothesis.

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Dynamic Partnerships Across Community, Academic and Policy Sectors: HPTN 071 The PopART Study

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  1. Dynamic Partnerships Across Community, Academic and Policy Sectors: HPTN 071The PopART Study Helen Ayles, on behalf of the HPTN071 study team

  2. Hypothesis Universal voluntary HIV testing with appropriate combination prevention offered to all those testing HIV negative - in addition to immediate ART for all those testing HIV positive - will have a substantial impact on HIV incidence at population level

  3. Trial Design • Average of ~50,000 in each cluster (~ 50% adults) • Incidence measured in Population Cohort: • 2,500 adults in each cluster, followed up after 1, 2 and 3 years

  4. PopART Intervention Package Facilitated by CHiPs Universal testing: annual door-to-door HBT Service promotion and referral for - HIV care for HIV +ve including PMTCT - VMMC - TB - STI Follow-up on referral • Support for: • Retention in care • Adherence • to treatment VMMC facility Health centre Universal treatment for HIV +ve irrespective of CD4 count CHiPs: Community HIV-care Providers PMTCT: Prevention of Mother to Child Transmission VMMC: Voluntary Medical Male Circumcision TB: Tuberculosis STI: Sexually Transmitted Infections

  5. HPTN071: Lessons in Partnership • HPTN071 is a huge community randomised trial, involving • Over 1 million participants • 21 communities • 8 district health authorities • 5 provincial health authorities • 4 Ministries/Departments of Health (SA Cape Town City health Dept., Government of W. Cape Health Directorate , Z Ministry of Health, Ministry of Community Development Mother and Child Health) • 3 USG agencies • 6 implementation partners • Study team of more than 800

  6. Funding Flows Research Implementation BMGF NIMH NIDA NIAID PEPFAR NIAID CDC USAID HPTN 3IE SCMS LSHTM Zambia SCMS ZPCTII CIDRZ ZAMBART Zambian Ministry of Health and Ministry of Community Development Mother and Child Health

  7. Coordination • Vital! • Designed structures at all levels giving representation to all stakeholders • District health authorities, community and implementers • National health authorities, implementers, USG agencies, community • National policy makers (MOH, MCDMCH), reps of international agencies (UNAIDS, WHO, PEPFAR), USG (CDC, USAID), civil society, community • International Advisory Group- reps from academia, civil society, international policy makers

  8. Funders Trial oversight DSMB/SMC/DAIDS-NIAID International Advisory Group Protocol Team ZAMBIA PopART Study team (ZAMBART) SOUTH AFRICA PopART Study Team (DTTC) Community partnership platform South Africa Trial Management team (SA-TMC) Zambia Trial Management Committee (Z-TMC) Zambia Intervention management team (Z-IMT) South Africa Intervention management team (SA-IMT) Zambia District intervention management teams (Z-DIMT) South Africa District/Sub district intervention coordination teams (CWICT & CMICT) ZAMBART district staff Implementing partners DTTC district staff Implementing partners MOH staff DOH Community advisory boards Community advisory boards

  9. What is “Community”? • 21 “ communities”- geographical catchment area of one health facility • Not necessarily a natural community, may be part of a community or made up of many communities • Communities of PLWH • How do they fit into the trial communities? • Communities of health implementers • Government health providers • NGO health providers • Community based organisations • Faith based organisations

  10. Community Engagement Zambia Trial Management Committee (Z-TMC) Zambia Implementation Management Team (Z-IMT) National Level Z-DIMT Community partners platform National Community Advisory Board (NCAB) Community Advisory Board (CAB) Communityand District Levels CBO reps Community stakeholder reps Opinion leaders/ G keepers

  11. Dynamism • Partnerships evolve • First discussions with community and national health authorities several years prior to trial being funded • Discussions with all partners prior to submission of proposal • Some partnerships develop more slowly than others, some happen spontaneously, some have to be worked at • Changing relationships as the trial progresses • We may not all be natural partners • Different language ( even if many of us use “English”) • Different cultures • Different skills • Different education and socio-economic status • Different power balances • Different expectations

  12. Sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under Cooperative Agreements # UM1 AI068619, UM1-AI068617, and UM1-AI068613 Funded by: The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) The International Initiative for Impact Evaluation (3ie) with support from the Bill & Melinda Gates Foundation NIAID, the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) all part of the U.S. National Institutes of Health (NIH) acknowledgements

  13. The HPTN 071 Study Team, led by: Dr. Richard Hayes Dr. Sarah Fidler Dr. Helen Ayles Dr. Nulda Beyers Government Agencies: Implementing Partners: PEPFAR Implementing Partners

  14. All research participants and their families The 21 research communities and their religious, traditional, secular and civil leadership structures Volunteers in the community advisory board structures With thanks to:

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