Share
   
Title
From trials to programmes: Lessons learned from four trials of Universal Testing and Treatment (UTT) in Sub-Saharan Africa
Code
TUBS01
Session Type
Bridging Session
Venue
Elicium 2
Date Time
Tuesday 24 July, 11:00 - 12:30
Co-Chairs:
David Serwadda, Makerere University School of Public Health, Uganda
Richard John Hayes, London School of Hygiene and Tropical Medicine, United Kingdom

HIV prevalence in sub-Saharan Africa (SSA) continues largely unchanged, while globally incidence is declining but too slowly for sustainable provision of care. There remain critical gaps in all aspects of the continuum of HIV prevention and care that need to be defined and addressed to achieve zero new infections and an AIDS-free future. Four large community-randomised trials have been carried out to measure the impact on HIV incidence of universal test-and-treat (UTT) interventions in high burden, resource-limited settings, in predominantly rural communities in Uganda, Kenya, Botswana and South Africa; and in predominantly urban communities in Zambia and South Africa.

This session will explore the lessons learned from innovative community-wide approaches designed to enhance coverage against the UNAIDS 90-90-90 targets. It will compare data from the four trials using cross-disciplinary approaches, and open for wider debate the implications and generalizability of their findings.

11:00
TUBS0101 		Introduction
Richard John Hayes, London School of Hygiene and Tropical Medicine, United Kingdom
Slides
11:05
TUBS0102 		Comparing and contrasting the study designs of the four UTT trials
Joanna Orne-Gliemann, INSERM U987 – Université Victor Segalen Bordeaux 2, France
PDF
11:20
TUBS0103 		Estimates of coverage against the 90:90:90 UNAIDS targets: Comparison of methods and findings
Kalpana Sabapathy, London School of Hygiene and Tropical Medicine, United Kingdom
Slides
11:35
TUBS0104 		Where are the coverage gaps? Data from the four UTT trials
Shahin Lockman, Harvard T.H. Chan School of Public Health, United States
Slides
11:50
TUBS0105 		Research on HIV-related stigma across UTT trials
Carol S. Camlin, University of California - San Francisco, United States
Slides
12:05
TUBS0106 		Panel discussion
Deenan Pillay, Africa Centre for Population Health, South Africa
Helen Ayles, Zambart, Zimbabwe
Refeletswe Lebelonyane, Botswana Ministry of Health and Wellness, Botswana
Diane Havlir, University of California, San Francisco, United States
Fiona Walsh, Clinton Health Access Initiative, United States
12:25
TUBS0107 		Closing remarks
AUTHOR
Bernadette Hensen
SUMMARY
The Universal Test and Treat Trials Consortium presented details of four UTT trials. Speakers compared the trial design and interventions, and presented pre- and 2-year post-intervention estimates of coverage against UNAIDS 90-90-90 and levels of stigma. A panel discussion with the lead investigators of five UTT trials followed the presentations.
HIGHLIGHTS
As described by Joanna Orne-Gliemann, the designs and objectives of the trials are broadly similar but the contexts where the interventions are being implemented differ as do some intervention components. Kalpana Sabapathy presented estimates of coverage against UNAIDS 90-90-90 targets, showing that BCPP (Botswana) and SEARCH (Uganda & Kenya) achieved >73% viral suppression 2-years post-intervention. Shahin Lockman presented pre-interventions patterns of lower coverage in each step of the cascade among men and younger people. After ~2-years of intervention, gaps “persisted but narrowed” through a combination of approaches implemented to reach youth and men. Carol Camlin described the heterogenous levels of stigma across and within trial sites, and presented evidence supportive of declines in stigma via specific pathways in some of the settings. In SEARCH, qualitative research suggests community members no longer consider it socially normative to stigmatize PLHIV. The panellists shared their lesson learnt, reflecting on the “power of communities”.
CRITICAL ASSESSMENT
The UT3C provides a unique opportunity to bring together data from five UTT trials and enhance our understanding of HIV epidemiology and control. The data presented reiterate that younger people and men are challenging to reach, but that services tailored to their needs can reach these groups. Mobility was a key challenge raised, with implications for intervention delivery and outcome measurement, and combination prevention raised as key to ending the HIV epidemic. The take home message from the panellist was the “power of communities”, in changing attitudes towards and leading implementation of interventions.
AUTHOR
Graeme Meintjes
SUMMARY
Investigators from four large community-randomised trials recently conducted in sub-Saharan Africa to measure the impact of universal test-and-treat (UTT) interventions on HIV incidence (SEARCH, TasP, BCPP and PopART) jointly presented. The focus was on findings regarding attainment of 90-90-90 targets in intervention communities and changes in stigma observed.
HIGHLIGHTS
Joanna Orne-Gliemann compared study designs: community intervention strategies varied, but specific strategies to engage groups less likely to be aware of their status or engaged in care was common to all. Kalpana Sabapathy showed that the proportion of HIV-infected individuals in care with a suppressed viral load in intervention communities ranged from 48%-85% at ~2 years across trials. She highlighted the challenges of estimating achievement of 90-90-90 targets where population flux affects reliability of estimates. Shahin Lockman presented data showing that in all 4 trials, coverage of each step of the 90-90-90 cascade was lower in men and in younger persons at baseline. While these gaps persisted post-intervention in each trial, they narrowed substantially when a combination of approaches were put in place to specifically target men and younger people in the community. Finally, Carol Camlin discussed the potential synergies that exist for UTT and stigma reduction.
CRITICAL ASSESSMENT
These trials were largely integrated with routine clinical care. They provide important lessons for programmatic settings about successful models and challenges for meeting 90-90-90 targets. Insights have been gained as to what interventions can be successfully implemented to engage those groups who are at highest risk of not being in HIV care with a suppressed viral load (men, younger people, mobile populations). Not all interventions will be scalable due to cost, but these trials provide an indication of what the most beneficial interventions are. The impressive reductions in stigma following fairly short-term UTT interventions provides reason for optimism.