Effect of Universal Testing and Treatment on HIV Incidence – HPTN 071 (PopART)

Replication paper
Original publication: The New England Journal of Medicine
Original researchers: Richard J Hayes, Deborah Donnell, Sian Floyd, Nomtha Mandla, Justin Bwalya, Kalpana Sabapathy, Blia Yang, Mwelwa Phiri, Ab Schaap, Susan H Eshleman, Estelle Piwowar‑Manning, Barry Kosloff, Anelet James, Timothy Skalland, Ethan Wilson, Lynda Emel, David Macleod, Rory Dunbar, Musonda Simwinga, Nozizwe Makola, Virginia Bond, Graeme Hoddinott, Ayana Moore, Sam Griffith, Nirupama Deshmane Sista, Sten H Vermund, Wafaa El‑Sadr, David N Burns, James R Hargreaves, Katharina Hauck, Christophe Fraser, Kwame Shanaube, Peter Bock, Nulda Beyers, Helen Ayles, Sarah Fidler
Replication researchers: Sridevi K Prasad, Eric W Djimeu, Douglas M Glandon
Current status: Replication Plan Published

The Original Study

The HPTN 071 (PopART) trial examined if a universal test and treatment programme along with a combination prevention intervention could reduce HIV incidence at the population level (Hayes et al. 2019). The trial was conducted in urban communities in Zambia and South Africa and is one of the four trials looking at treatment as prevention. Both intervention groups received the combination prevention intervention, with one group receiving ART regardless of the patient’s CD4 cell counts and the other receiving treatment according to the national guidelines. The control group received standard of care with treatment according to the national guidelines. In 2014, Zambia adopted the WHO guidelines to provide ART at CD4 cell counts less than 500 cells/μL while South Africa adopted these guidelines at the end of 2014 (Department of Health 2014; Ministry of Health Zambia 2014). In 2016, both countries adopted the WHO recommendations to provide universal ART at all clinics (Republic of South Africa Department of Health 2016; Republic of Zambia Ministry of Health 2016). The PopART trial found that the universal ART intervention group did not have an effect on HIV incidence relative to the control group. However, they found that if the two combination prevention treatment arms were combined, HIV incidence was 20 per cent lower in the treatment arms compared to the control group.