HPTN 071 (PopART) : a cluster-randomized trial of the population impact of an HIV combination prevention intervention including universal testing and treatment : mathematical model

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dc.contributor.authorCori, Anneen_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorBeyers, Nuldaen_ZA
dc.contributor.authorSchaap, Aben_ZA
dc.contributor.authorFloyd, Sianen_ZA
dc.contributor.authorSabapathy, Kalpanaen_ZA
dc.contributor.authorEaton, Jeffrey W.en_ZA
dc.contributor.authorHauck, Katharinaen_ZA
dc.contributor.authorSmith, Peteren_ZA
dc.contributor.authorGriffith, Samen_ZA
dc.contributor.authorMoore, Ayanaen_ZA
dc.contributor.authorDonnell, Deborahen_ZA
dc.contributor.authorVermund, Sten H.en_ZA
dc.contributor.authorFidler, Sarahen_ZA
dc.contributor.authorHayes, Richarden_ZA
dc.contributor.authorFraser, Christopheen_ZA
dc.date.accessioned2016-03-09T05:44:00Z
dc.date.available2016-03-09T05:44:00Z
dc.date.issued2014-01-15
dc.descriptionPlease cite as follows: Cori, A. et al. 2014. HPTN 071 (PopART) : a cluster-randomized trial of the population impact of an HIV combination prevention intervention including universal testing and treatment : mathematical model. PLoS ONE, 9(1):e84511, doi:10.1371/journal.pone.0084511.en_ZA
dc.descriptionThe original publication is available at http://journals.plos.org/plosoneen_ZA
dc.description.abstractBackground: 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 the design and monitoring of a new trial aiming to test whether widespread provision of ART is feasible and can substantially reduce population-level HIV incidence. Methods and Findings: The HPTN 071 (PopART) trial is a three-arm cluster-randomized trial of 21 large population clusters in Zambia and South Africa, starting in 2013. A combination prevention package including home-based voluntary testing and counseling, and ART for HIV positive individuals, will be delivered in arms A and B, with ART offered universally in arm A and according to national guidelines in arm B. Arm C will be the control arm. The primary endpoint is the cumulative three-year HIV incidence. We developed a mathematical model of heterosexual HIV transmission, informed by recent data on HIV-1 natural history. We focused on realistically modeling the intervention package. Parameters were calibrated to data previously collected in these communities and national surveillance data. We predict that, if targets are reached, HIV incidence over three years will drop by >60% in arm A and >25% in arm B, relative to arm C. The considerable uncertainty in the predicted reduction in incidence justifies the need for a trial. The main drivers of this uncertainty are possible community-level behavioral changes associated with the intervention, uptake of testing and treatment, as well as ART retention and adherence. Conclusions: The HPTN 071 (PopART) trial intervention could reduce HIV population-level incidence by >60% over three years. This intervention could serve as a paradigm for national or supra-national implementation. Our analysis highlights the role mathematical modeling can play in trial development and monitoring, and more widely in evaluating the impact of treatment as prevention.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0084511
dc.description.versionPublisher's versionen_ZA
dc.format.extent11 pagesen_ZA
dc.identifier.citationCori, A. et al. 2014. HPTN 071 (PopART) : a cluster-randomized trial of the population impact of an HIV combination prevention intervention including universal testing and treatment : mathematical model. PLoS ONE, 9(1):e84511, doi:10.1371/journal.pone.0084511.en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0084511
dc.identifier.urihttp://hdl.handle.net/10019.1/98262
dc.language.isoen_ZAen_ZA
dc.publisherPLoSen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectHIV (Viruses) -- Preventionen_ZA
dc.subjectHIV infections -- Preventionen_ZA
dc.subjectAntiretroviral therapyen_ZA
dc.subjectAntiretroviral agents -- Mathematical modelsen_ZA
dc.titleHPTN 071 (PopART) : a cluster-randomized trial of the population impact of an HIV combination prevention intervention including universal testing and treatment : mathematical modelen_ZA
dc.typeArticleen_ZA
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