Title

Towards zero new HIV infections: Lessons learnt from the HPTN 071 (PopART) trial

Code

MOSY03

Session Type

Symposia Session

Venue

Palacio de Valparaíso 1

Date Time

Monday 22 July, 11:00 - 12:30

Chair:

Connie Celum, University of Washington, United States

HPTN 071 (PopART) is a community-randomized trial in 21 urban, high HIV-prevalence, resource-limited communities in Zambia and South Africa. The trial was designed to measure the impact of a combination HIV prevention package, including universal HIV testing and treatment (UTT), on HIV incidence at a population level.
Whilst the overall impact on population-level HIV incidence is a key outcome, other important outcomes of the study will need to be considered to understand results and inform policy and implementation.

11:00 MOSY0301	Introduction

11:05 MOSY0302	HPTN 071 (PopART) trial: impact of a UTT intervention on HIV incidence Richard John Hayes, London School of Hygiene and Tropical Medicine, United Kingdom Sarah Fidler, Imperial College London, United Kingdom

11:25 MOSY0303	Model projections of the impact of the PopART intervention William Probert, Big Data Institute, University of Oxford, United Kingdom	PDF

11:40 MOSY0304	Cost and societal value of the household-based combination HIV prevention intervention implemented in HPTN 071 (PopART) Katharina Hauck, Imperial College London, United Kingdom

11:55 MOSY0305	Community and Stakeholder engagement in the HPTN071 (PopART) trial Musonda Simwinga, Zambart, Zambia	Slides

12:10 MOSY0306	Panel discussion Ambassador Deborah Birx, US President's Emergency Plan for AIDS Relief (PEPFAR), United States Marijke Wijnroks, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Switzerland Solange Baptiste, International Treatment Preparedness Coalition, South Africa Meg Doherty, World Health Organization, Switzerland

AUTHOR

James McMahon

SUMMARY

HPTN 071 (PopART) randomised 21 communities in Zambia and South Africa to: standard of care and 2 intervention arms (universal HIV testing and VMMC with universal ART, or ART by country guidelines) to see if HIV incidence could be reduced. Efficacy, cost-effectiveness, modelling and community engagement was presented.

HIGHLIGHTS

The intervention reduced HIV incidence by 19% (combined intervention arms versus SOC) and achieved UNAIDS 90-90-90 targets. The universal ART arm (Arm A) had a non-significant reduction in incidence (7%, p=0.51) versus SOC. Multiple data sources from the Arm A (Higher levels of viral suppression, sexual risk/infection data, migration data) does not support the hypothesis that Arm A: was poorly delivered, had informed consent as a barrier to enrolment, led to sexual risk disinhibition and contained higher migration. Therefore, the most likely reason for the difference in Arms A and the other intervention arm was chance. So, data from these 2 intervention arms can be combined showing a reduction in HIV incidence of 19% and, ‘The most appropriate measure of the effect of this intervention” Prof Richard Hayes. Modelling and cost-effectiveness data shows that this intervention has a sustained effect over time and is cost-effective according to WHO guidance.

CRITICAL ASSESSMENT

The positive results of this trial compared to other population based universal test and treat trials (ANRS 12249 TasP and SEARCH) is critical to inform the HIV response in sub-Saharan countries with generalised HIV epidemics (Published July 18, 2019. N Engl J Med). The potential for sustained benefits and cost-effectiveness (but not cost saving) when this intervention was modelled into the future will allow countries in the region to consider the widespread implementation and benefits of universal testing and treatment.