Controlling the HIV epidemic: A progress report on efforts in sub-Saharan Africa

In a Research Article published in PLOS Medicine, Richard Hayes of the London School of Hygiene & Tropical Medicine, UK and colleagues report early findings from PopART--a clinical trial evaluating an intervention to achieve universal HIV testing and treatment--in Zambia. The authors estimate that, after 1 y of the intervention, the proportion of people with HIV who knew their infection status had increased from 52% to 78% (men) and from 56% to 87% (women); and that the overall proportion of people with HIV receiving antiretroviral treatment (ART) had increased from 44% to 61%.

Despite progress against the HIV epidemic, some 2.1 million people were newly infected with HIV in 2015, according to the most recent estimates from UNAIDS (the joint United Nations Programme on HIV/AIDS). In that year, more than a million people died from HIV-related illnesses, mostly in low- and middle-income countries. To accelerate progress against this disastrous toll of ill health and mortality, UNAIDS has set ambitious "90-90-90" targets: by 2020, 90% of people infected with HIV should know their status, with 90% of people diagnosed with HIV infection to be receiving ART and 90% of people receiving treatment to have viral suppression. PopART and other large studies are aiming to evaluate programmes for universal testing and treatment towards these goals and to measure their effect on the number of new HIV infections.

PopART (also known as HPTN 071) is being implemented in 21 urban communities in Zambia and South Africa with a total population of around 1 million. The new paper reports findings from the first year of the study in Zambia only. In PopART, community HIV care providers systematically visit people in their homes to offer HIV testing and counselling, with linkage to appropriate facility-based care and follow-up for people with HIV, tuberculosis and other diseases. Hayes and colleagues report that, after 1 y, the estimated population proportion of those with HIV infection knowing their status was close to the UNAIDS target in women (87%); the lower proportion in men (78%) suggests that reaching men through home visits may be challenging. Although the estimated proportion of HIV-positive people on ART increased from 44% to 61%, this falls short of the 81% target (90% of 90%). The data also suggest that ART coverage was lower in younger adults with HIV. The trial is ongoing, and additional findings will be reported in future years.

Collins Iwuji and Marie-Louise Newell discuss the research in an accompanying Perspective, concluding that "Overall, these results would suggest that it is unlikely that the rather optimistic forecasts...of an imminent end to the global HIV epidemic will be fulfilled. Substantial resources are needed to further scale up ART for all HIV-positive adults, and allocation of limited resources will need to be optimised on the basis of evidence of efficacy."

###

HPTN 071 is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under Cooperative Agreements UM1-AI068619, UM1-AI068617, and UM1-AI068613, with funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Additional funding is provided by the International Initiative for Impact Evaluation (3ie) with support from the Bill & Melinda Gates Foundation, as well as by NIAID, the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), all part of the U.S. National Institutes of Health (NIH). The funders had no role in data collection, data analysis, or the decision to publish this manuscript. 3ie reviewed and provided non-binding comments on the draft manuscript prior to journal submission. The trial sponsor, NIH, reviewed and approved the original design of the HPTN 071 study and approves all changes to the study protocol.

The authors have declared that no competing interests exist.

Hayes R, Floyd S, Schaap A, Shanaube K, Bock P, Sabapathy K, et al. (2017) A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial. PLoS Med 14(5): e1002292. https://doi.org/10.1371/journal.pmed.1002292

Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
Zambart, University of Zambia School of Medicine, Lusaka, Zambia
Desmond Tutu TB Centre, Department of Paediatrics and Child Health, University of Stellenbosch, Stellenbosch, South Africa
FHI 360, HIV Prevention Trials Network, Durham, North Carolina, United States of America
HIV Prevention Trials Network Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention, Seattle, Washington, United States of America
HIV Prevention Trials Network Laboratory Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
Mailman School of Public Health, Columbia University, New York, New York, United States of America
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
HIV Clinical Trials Unit, Imperial College London, London, United Kingdom

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002292

The authors received no specific funding for this work.

I have read the journal's policy and have the following conflicts: CI received honoraria for consulting services rendered to Gilead Sciences. CI is also a co-investigator in the ANRS 12249 TasP trial. MLN is a principal investigator in the ANRS 12249 TasP trial and is a member of the Editorial Board of PLOS Medicine.

Iwuji C, Newell M-L (2017) Towards control of the global HIV epidemic: Addressing the middle-90 challenge in the UNAIDS 90-90-90 target. PLoS Med 14(5): e1002293. https://doi.org/10.1371/journal.pmed.1002293

Research Department of Infection and Population Health, University College, London, United Kingdom

Africa Health Research Institute, KwaZulu-Natal, South Africa
Human Development and Health and Global Health Research Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002293