1. HPTN 071 (PopART): Have we reached the 90-90-90 targets after two years of the PopART intervention
IAS Paris July 2017
Richard Hayes

2. acknowledgements
Sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under Cooperative Agreements # UM1 AI068619, UM1-AI068617, and UM1-AI068613
Funded by:
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR)
The International Initiative for Impact Evaluation (3ie) with support from the Bill & Melinda Gates Foundation
NIAID, the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) all part of the U.S. National Institutes of Health (NIH)

3. ~ 2,000 random sample from each community : HIV incidence at 36 months
Original Trial Design
Total Population ~ 1M
~ 2,000 random sample from each community :
Population Cohort
N ~ 43,000
12 in Zambia
9 in S. Africa
Primary outcome:
HIV incidence at 36 months
PopART intervention package
Annual rounds of Home Based Voluntary HIV Testing by Community HIV-care Providers (CHiPs)
Health promotion, Active Referral and/or Retention in Care support by CHiPs for the following:
Voluntary Medical Male Circumcision (VMMC) for HIV negative men
Prevention of Mother to Child Transmission (PMCT) for HIV positive women
HIV treatment and care for all HIV positive individuals
Promotion of sexual health and TB services
Condom provision
ART irrespective of CD4-count or immune-status provided at the local health centre in Arm A

4. Revised Trial Design
12 in Zambia
9 in S. Africa
Key difference between Arms A&B vs Arm C is the community-based activities:
Regular house-to-house HIV testing and re-testing
Active linkage and follow-up for HIV+
Adherence support for HIV+
Condom promotion/distribution, VMMC referral, STI counseling, PMTCT referral
Active case finding and follow-up for TB

6. HPTN 071 Timeline
Study intervention will finish by the end of December 2017 and data on process measures can be shared mid 2018 the main trial primary endpoint will report at CROI 2019.

7. Assumptions made to estimate overall community knowledge of HIV status and on ART
HIV prevalence in those who “do not know status” after CHiPs visit same as in those who accept HCT
Among those consenting to intervention, all HIV+ who knew their status self-reported this to the CHiP
HIV prevalence in those not consenting to intervention same as in those consenting
Proportion of HIV+ who knew their status same in those not consenting as in those consenting (at time of CHiP visit)
Proportion of known HIV+ on ART same in those not consenting as in those consenting (at time of CHiP visit)

8. 1st 90: Percentage of HIV+ adults who know their HIV+ status
90-90 estimates, Zambia Arm A, with extrapolation to total adult population
First 90 (%)
Second 90 (%)
Estimated number of HIV+ adults
Immediately before annual round (AR) visit
End Round
Immediately after annual round (AR) visit
Men
Round 1 (R1)
6649 52 78 54 74
Round 2 (R2)
6521 67 79 71 81
Women
11037 56 87 53 73
10690 75 91 82
Round 2, Overall
17211
1st 90: Percentage of HIV+ adults who know their HIV+ status
2nd 90: Percentage of HIV+ adults who are on ART, among those who know their HIV+ status

9. 1st 90 estimates, Zambia Round 2 Arm A, with extrapolation to total adult population

10. 2nd 90 estimates, Zambia Round 2 Arm A, with extrapolation to total adult population

11. ART initiation – based on self-reported information
Time from CHiP referral to ART initiation, Zambia & South Africa Arm A comparing Round 1 and 2
In Round 2, ~50% started ART by 6 months after referral, compared with
~40% in Round 1
Median reduced from ~9-10m to 5-6m
ART initiation – based on self-reported information
CHiP teams request to see patient ART card, on which ART initiation is documented
Analysis includes all HIV+ individuals who were referred to HIV care, and were not on ART when referred

12. 90-90 estimates, Zambia Arm A, with extrapolation to total adult population
First 90 (%)
Second 90 (%)
Estimated number of HIV+ adults
Immediately before AR visit
End Round
Immediately after AR visit
Men
Round 1 (R1)
6649 52 78 54 74
Round 2 (R2)
6521 67 79 71 81
R2, participated R1
2856 87 92 85
R2, not participated R1
3665 51 70 63 77
Women
11037 56 53 73
10690 75 91 82
5885 89 96 86
4805 58 61 76

13. Summary
After second annual round of CHiP intervention in Zambia, we estimate that 87% of HIV+ adults knew their status overall – close to First 90
This had increased from 50-55% prior to intervention
Knowledge of HIV+ status was lower in men than women (79% vs 91%)
Of known HIV+ adults, 82% were on ART by end of second round
Knowledge of HIV+ status and ART coverage lower in young adults than older adults
Linkage to care following referral is now much faster than before
Rates of mobility/migration in these mainly urban settings are high emphasising importance of frequent testing and re-testing
Coverage will be re-examined after third annual round later this year

14. And now… some HPTN 071 sub-studies
PopART in youth (P-ART-Y)
Social science
Stigma ancillary study
Health economics
Mathematical modelling

15. The HPTN 071 Study Team, led by: PEPFAR Implementing Partners:
Dr. Richard Hayes
Dr. Sarah Fidler
Dr. Helen Ayles
Dr. Nulda Beyers
Government Agencies:
PEPFAR Implementing Partners:

16. With thanks to: All research participants and their families
The 21 research communities and their religious, traditional, secular and civil leadership structures
Volunteers in the community advisory board structures