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Reaching 90-90-90 Targets with PopART Intervention after 2 Years: HPTN.071 Study

This study examines the progress towards achieving the 90-90-90 targets in HIV prevention and treatment after two years of implementing the PopART intervention. The study focuses on the impact of community-based activities on HIV testing, treatment initiation, and overall community knowledge of HIV status and ART coverage.

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Reaching 90-90-90 Targets with PopART Intervention after 2 Years: HPTN.071 Study

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  1. HPTN 071 (PopART): Have we reached the 90-90-90 targets after two years of the PopART intervention IAS Paris July 2017 Richard Hayes

  2. 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

  3. Original Trial Design Total Population ~ 1M ~ 2,000 random sample from each community : Population Cohort N ~ 43,000 12 in Zambia 9 in S. Africa Primary outcome: HIV incidence at 36 months • PopART intervention package • Annual rounds of Home Based Voluntary HIV Testing by Community HIV-care Providers (CHiPs) • Health promotion, Active Referral and/or Retention in Care support by CHiPs for the following: • Voluntary Medical Male Circumcision (VMMC) for HIV negative men • Prevention of Mother to Child Transmission (PMCT) for HIV positive women • HIV treatment and care for all HIV positive individuals • Promotion of sexual health and TB services • Condom provision • ART irrespective of CD4-count or immune-status provided at the local health centre in Arm A

  4. Revised Trial Design 12 in Zambia 9 in S. Africa • Key difference between Arms A&B vs Arm C is the community-based activities: • Regular house-to-house HIV testing and re-testing • Active linkage and follow-up for HIV+ • Adherence support for HIV+ • Condom promotion/distribution, VMMC referral, STI counseling, PMTCT referral • Active case finding and follow-up for TB

  5. HPTN 071 Timeline

  6. HIV prevalence in those who “do not know status” after CHiPs visit same as in those who accept HCT Among those consenting to intervention, all HIV+ who knew their status self-reported this to the CHiP HIV prevalence in those not consenting to intervention same as in those consenting Proportion of HIV+ who knew their status same in those not consenting as in those consenting (at time of CHiP visit) Proportion of known HIV+ on ART same in those not consenting as in those consenting (at time of CHiP visit) Assumptions made to estimate overall community knowledge of HIV status and on ART

  7. 90-90 estimates, Zambia Arm A, with extrapolation to total adult population 1st 90: Percentage of HIV+ adults who know their HIV+ status 2nd 90: Percentage of HIV+ adults who are on ART, among those who know their HIV+ status

  8. 1st 90 estimates, Zambia Round 2 Arm A, with extrapolation to total adult population

  9. 2nd 90 estimates, Zambia Round 2 Arm A, with extrapolation to total adult population

  10. Time from CHiP referral to ART initiation, Zambia & South Africa Arm A comparing Round 1 and 2 In Round 2, ~50% started ART by 6 months after referral, compared with ~40% in Round 1 Median reduced from ~9-10m to 5-6m ART initiation – based on self-reported information CHiP teams request to see patient ART card, on which ART initiation is documented Analysis includes all HIV+ individuals who were referred to HIV care, and were not on ART when referred

  11. 90-90 estimates, Zambia Arm A, with extrapolation to total adult population

  12. After second annual round of CHiP intervention in Zambia, we estimate that 87% of HIV+ adults knew their status overall – close to First 90 This had increased from 50-55% prior to intervention Knowledge of HIV+ status was lower in men than women (79% vs 91%) Of known HIV+ adults, 82% were on ART by end of second round Knowledge of HIV+ status and ART coverage lower in young adults than older adults Linkage to care following referral is now much faster than before Rates of mobility/migration in these mainly urban settings are high emphasising importance of frequent testing and re-testing Coverage will be re-examined after third annual round later this year Summary

  13. PopART in youth (P-ART-Y) Social science Stigma ancillary study Health economics Mathematical modelling And now… some HPTN 071sub-studies

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

  15. 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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