HPTN 043 Project Accept study published in the Lancet Infectious Diseases demonstrates that community mobilization boosts HIV testing rates in developing countries
The addition of community mobilization activities and support services to a mobile HIV counseling and testing program can greatly improve the rates of initial and repeat testing in remote rural communities, according to new research supported by the HIV Prevention Trials Network (HPTN) and the National Institute of Mental Health (NIMH).
HPTN is a partnership among scientists and communities around the world, funded by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), and dedicated to reducing the transmission of HIV. FHI serves as the Coordinating and Operations Center (CORE) for HPTN. As the CORE, FHI is responsible for the scientific management of HPTN and provides primary support for HPTN committees, scientific working groups, protocol teams, and Community Advisory Boards.
"Knowledge of HIV status is an important gateway to prevention and treatment services. This study answers the question of how best to scale up testing in resource-limited settings," says Quarraisha Abdool Karim, HPTN co-principal investigator and associate scientific director of CAPRISA. "It shows HIV testing becomes more accessible through a community-based approach. In developing countries, most people infected with HIV do not know their infection status."
"An essential component of any prevention effort is to combine interventions both for HIV-infected and uninfected persons," adds Sten Vermund, HPTN co-principal investigator and Amos Christie Chair of Global Health at the Vanderbilt University School of Medicine. "The NIMH Project Accept/HPTN 043 team has demonstrated that a radical increase in testing acceptance is feasible in highly diverse rural and urban settings in both Africa and Asia. This vital clinical trial discovery gives us hope that prevention and treatment programs can reach people who know their HIV status."
HPTN 043 is the first international randomized controlled Phase III trial to determine the efficacy of a community-level intervention with an HIV incidence endpoint. Communities in each setting were paired according to demographic characteristics, and one of each pair was then randomized to receive either clinic-based voluntary counseling and testing alone or a combination of clinic-based testing and community-based testing. The community-based testing included mobile HIV testing along with community mobilization and post-test psychosocial support services. The results of the impact of this intervention on new HIV infections will be available in 2012.
The researchers found that the proportion of persons who received their first HIV test during the study was higher in areas that received the "combination" testing than in those areas that received "stand-alone" clinic-based testing in Tanzania (37 percent vs. 9 percent), Zimbabwe (51 percent vs. 5 percent), and Thailand (69 percent vs. 23 percent).
Although the HIV prevalence rate was higher in the stand-alone testing areas than in the areas that received combination testing, the programs in the combination-testing areas detected almost four times more HIV cases (952 vs. 264) because they were able to test a greater number of people. Repeat HIV testing in areas that received the combination testing increased at all sites, reaching 28 percent of all those who were tested by the end of the intervention period.
Previous studies have shown that men are often difficult to reach with HIV prevention services. In this study a larger proportion of male clients received HIV tests in the combination-testing areas compared to the stand-alone testing areas. Few clients tested for HIV infection as couples in Tanzania and Zimbabwe but the proportion of clients who tested as part of a couple in Thailand was much higher than it was at other sites.
"Communities can be mobilized to learn their HIV infection status, including in remote rural communities with little infrastructure across different regions, epidemic settings, and cultures," said HPTN Protocol Chair of the study, Thomas Coates, professor of medicine and director of the University of California, Los Angeles (UCLA) Program in Global Health. The trial demonstrated that "local communities respond to HIV epidemics when comprehensive, user-friendly services are provided," he added.
HPTN 043 is a Phase III trial testing the feasibility of a community-wide HIV counseling testing approach to prevention, using HIV and incidence as an endpoint in Tanzania, Thailand, and Zimbabwe. The trial is funded by the National Institute of Mental Health, and is supported by the HIV Prevention Trials Network. Additional support has been provided by the Office of AIDS Research of the National Institutes of Health.
 Sweat M, Morin S, Celentano D, et al. Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): A randomised study. Lancet Infectious Diseases; published online May 4, 2011.