HIV in sub-Sahara Africa: Testing and treatment start at home improves therapy

March 6, 2018, Swiss Tropical and Public Health Institute
HIV infecting a human cell. Credit: NIH

Lesotho, in southern Africa, is one of the worst hit countries by the HIV/AIDS epidemic worldwide. Indeed, a quarter of the adult population is infected with HIV. Many people however do not know their HIV status and, hence, are not undergoing treatment. In the remote mountainous regions of Lesotho, access to HIV testing and treatment is especially challenging. Bad roads and the need to walk for hours to access the nearest health centre prevents patients from beginning antiretroviral therapy (ART) or causes them to Interrupt treatment prematurely.

A clinical study, designed by Niklaus Labhardt and his group at the Swiss Tropical and Public Health Institute (Swiss TPH) validated a new approach. Field teams from SolidarMed, a Swiss NGO, visited remote villages in the North of Lesotho. Community health counsellors and trained-nurses approached every village household and offered a voluntary HIV test to the residents. Those who tested positive received information about ART and were offered to commence at home on the same day. This approach allowed patients to start therapy without having to attend a distant clinic.

An important step towards achieving the 90-90-90 targets

"With this strategy, we reach living in remote rural areas who would normally not get tested or start the lifesaving ART. The nearest clinic is often too far away and the journey too expensive, " said principal investigator and HIV specialist, Niklaus Labhardt, currently at the University Hospital Basel. "With this simple strategy, we can offer patients faster and more successful therapy options." The results demonstrate a proof-of concept of this novel approach and were published today in the Journal of the American Medical Association (JAMA) and presented at the "Conference on Retroviruses and Opportunistic Infections" in Boston.

Compared to standard strategies, the number of treated patients increased significantly. Three months after the initial HIV-test at home, 69% of patients were undergoing - an increase of 26% over the standard approach (43%). Adherence to the therapy was also higher among patients. A year after starting therapy, HIV was no longer detectable in half of the , meaning that they will not develop AIDS and infect other people with HIV. In contrast, only one-third of those following the conventional treatment strategy had undetectable viruses after one year.

The study is one of the first clinical trials to test a strategy for reaching the 90-90-90 objectives of the World Health Organization (WHO) and the UN programme, UNAIDS. The 90-90-90 targets postulate that by 2020, 90% of HIV-infected people should know their HIV status, at least 90% of those testing positive should receive ART and in 90% of those undergoing therapy, the virus is suppressed. ART has both a therapeutic and a preventive effect, as people undergoing ART cannot transmit HIV to their sexual partners.

"Our study is an important step toward 90-90-90," said Niklaus Labhardt. "This new should be integrated in routine care in southern Africa to increase access to life-saving HIV therapy."

Explore further: Home- versus mobile clinic-based HIV testing and counseling in rural Africa

More information: Labhardt ND, Ringera I, Lejone IT., Klimkait T, Muhairwe J, Amstutz A, Glass TR. Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: the CASCADE Clinical Trial. DOI: 10.1001/jama.2018.1818

The study will be presented on Tuesday, March 6, 2018 at the "Conference on Retroviruses and Opportunistic Infections" in Boston, MA, during a scientific lecture and at a media conference. www.croiconference.org

Related Stories

Home- versus mobile clinic-based HIV testing and counseling in rural Africa

December 16, 2014
Home- and community-based HIV testing and counselling services can achieve high participation uptake in rural Africa but reach different populations within a community and should be provided depending on the groups that are ...

One in two Africans don't know HIV status: expert

December 7, 2017
Thirty-five years after the start of the AIDS epidemic, one person in two in sub-Saharan Africa "does not know their HIV status," according to a French expert.

Men at higher risk of dying of AIDS than women: UNAIDS

December 1, 2017
Men are less likely to test for HIV or access antiretroviral therapy and, therefore, are more likely to die of AIDS-related illnesses than women, UNAIDS said on Friday.

Kenya's HIV progress report—good progress, but also big gaps

December 28, 2017
The World Health Organisation (WHO) has clear markers on the road to controlling the global HIV/AIDS pandemic. By 2020, about nine out of every ten people should know their HIV status. Nine out of ten HIV positive people ...

Immediate ART treatment improves retention rates

November 28, 2017
Starting antiretroviral therapy (ART) immediately following an HIV diagnosis dramatically improves retention in clinical HIV care, according to a study led by a Boston University School of Public Health (BUSPH) researcher.

As tide turns, AIDS claimed 1 million lives in 2016: UN (Update)

July 20, 2017
AIDS claimed a million lives in 2016, almost half the 2005 toll that marked the peak of the deadly epidemic, said a UN report Thursday proclaiming "the scales have tipped".

Recommended for you

New research highlights why HIV-infected patients suffer higher rates of cancer

December 5, 2018
AIDS patients suffer higher rates of cancer because they have fewer T-cells in their bodies to fight disease. But new research examines why HIV-infected patients have higher rates of cancer—among the leading causes of death ...

Focus on resistance to HIV offers insight into how to fight the virus

November 30, 2018
Of the 40 million people around the world infected with HIV, less than one per cent have immune systems strong enough to suppress the virus for extended periods of time. These special immune systems are known as "elite controllers." ...

Patients with rare natural ability to suppress HIV shed light on potential functional cure

November 27, 2018
Researchers at Johns Hopkins have identified two patients with HIV whose immune cells behave differently than others with the virus and actually appear to help control viral load even years after infection. Moreover, both ...

Scientists unveil promising new HIV vaccine strategy

November 26, 2018
A new candidate HIV vaccine from Scripps Research surmounts technical hurdles that stymied previous vaccine efforts, and stimulates a powerful anti-HIV antibody response in animal tests.

Influential U.S. panel backs PrEP HIV-prevention pills

November 20, 2018
(HealthDay)—For the first time, a highly influential panel of experts says doctors should offer a daily pill to prevent HIV transmission to people who are at high risk for infection with the AIDS-causing virus.

Majority of HIV persistence during ART due to infected cell proliferation

November 17, 2018
A majority of the HIV-infected cells that persist in HIV-infected individuals even during suppressive antiretroviral therapy (ART) originated from cellular proliferation, not viral replication, according to new research published ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.