HPTN 071 (PopART): A Cluster-Randomized Trial of the Population Impact of an HIV Combination Prevention Intervention Including Universal Testing and Treatment: Mathematical Model

• DOI: 10.1371/journal.pone.0084511
• Publication Date: 2014-01-15T21:18:19Z
• Authors: Anne Cori; Helen Ayles; Nulda Beyers; Ab Schaap; Sian Floyd; Kalpana Sabapathy; Jeffrey W. Eaton; Katharina Hauck; Peter Smith; Sam Griffith; Ayana Moore; Deborah Donnell; Sten H. Vermund; Sarah Fidler; Richard Hayes; Christophe Fraser
• Keywords: Cumulative incidence; Clinical endpoint

Background The HPTN 052 trial confirmed that antiretroviral therapy (ART) can nearly eliminate HIV transmission from successfully treated HIV-infected individuals within couples. Here, we present the mathematical modeling used to inform design and monitoring of a new aiming test whether widespread provision ART is feasible substantially reduce population-level incidence. Methods Findings 071 (PopART) three-arm cluster-randomized 21 large population clusters in Zambia South Africa, starting 2013. A combination prevention package including home-based voluntary testing counseling, for positive individuals, will be delivered arms B, with offered universally arm according national guidelines B. Arm C control arm. primary endpoint cumulative three-year We developed model heterosexual transmission, informed by recent data on HIV-1 natural history. focused realistically intervention package. Parameters were calibrated previously collected these communities surveillance data. predict that, if targets are reached, incidence over three years drop >60% >25% relative C. considerable uncertainty predicted reduction justifies need trial. main drivers this possible community-level behavioral changes associated intervention, uptake treatment, as well retention adherence. Conclusions could years. This serve paradigm or supra-national implementation. Our analysis highlights role play development monitoring, more widely evaluating impact treatment prevention.