Transcript Powerpoint

Dynamic Partnerships Across
Community, Academic and Policy
Sectors: HPTN 071
The PopART Study
Helen Ayles, on behalf of the HPTN071 study team
NATIONAL INSTITUTES OF HEALTH:
National Institute of Allergy and Infectious Diseases
National Institute of Mental Health
National Institute on Drug Abuse
Hypothesis
Universal voluntary HIV testing
with appropriate combination
prevention offered to all those
testing HIV negative - in addition
to immediate ART for all those
testing HIV positive - will have a
substantial impact on HIV
incidence at population level
Trial Design
3 arm cluster-randomised trial with 21 communities
(N ≈ 1.2million total population)
Arm A
Full PopART
intervention
including
immediate ART
irrespective of CD4
count
Arm B
Arm C
PopART intervention
Standard of care at
current service
provision levels
except
including
ART initiation
according to current
national guidelines*
ART initiation
according to current
national guidelines*
• Average of ~50,000 in each cluster (~ 50% adults)
• Incidence measured in Population Cohort:
2,500 adults in each cluster, followed up after 1, 2 and 3 years
PopART Intervention Package
Universal testing: annual
door-to-door HBT
Service promotion and
referral for
- HIV care for HIV +ve
including PMTCT
- VMMC
- TB
- STI
Follow-up
on referral
VMMC facility
Universal treatment for
HIV +ve
irrespective of CD4 count
Facilitated
by CHiPs
Support for:
- Retention in care
- Adherence
to treatment
Health
centre
CHiPs: Community HIV-care Providers
PMTCT: Prevention of Mother to Child Transmission
VMMC: Voluntary Medical Male Circumcision
TB: Tuberculosis
STI: Sexually Transmitted Infections
HPTN071: Lessons in Partnership
• HPTN071 is a huge community randomised trial,
involving
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Over 1 million participants
21 communities
8 district health authorities
5 provincial health authorities
4 Ministries/Departments of Health (SA Cape Town City
health Dept., Government of W. Cape Health Directorate
, Z Ministry of Health, Ministry of Community
Development Mother and Child Health)
– 3 USG agencies
– 6 implementation partners
– Study team of more than 800
Funding Flows
Research
BMGF
NIMH
NIDA
NIAID
NIAID
Implementation
PEPFAR
CDC
USAID
HPTN
3IE
SCMS
LSHTM
Zambia
ZAMBART
CIDRZ
ZPCTII
SCMS
Zambian Ministry of Health and Ministry of Community Development Mother and Child Health
Coordination
• Vital!
• Designed structures at all levels giving
representation to all stakeholders
– District health authorities, community and
implementers
– National health authorities, implementers, USG
agencies, community
– National policy makers (MOH, MCDMCH), reps of
international agencies (UNAIDS, WHO, PEPFAR),
USG (CDC, USAID), civil society, community
– International Advisory Group- reps from academia,
civil society, international policy makers
Funders
Trial oversight DSMB/SMC/DAIDSNIAID
International Advisory Group
PROTOCOL TEAM
Community
partnership
platform
ZAMBART
district staff
ZAMBIA PopART Study team
(ZAMBART)
SOUTH AFRICA PopART Study
Team (DTTC)
Zambia Trial Management
Committee (Z-TMC)
South Africa Trial Management
team (SA-TMC)
Zambia Intervention
management team (Z-IMT)
South
Africa
Intervention
management team (SA-IMT)
Zambia District intervention
management teams (Z-DIMT)
South Africa District/Sub district
intervention coordination teams
(CWICT & CMICT)
Community
advisory
boards
Implementing
partners
MOH
staff
DOH
Implementing
partners
Community
advisory
boards
DTTC
district
staff
What is “Community”?
• 21 “ communities”- geographical catchment
area of one health facility
– Not necessarily a natural community, may be part of
a community or made up of many communities
• Communities of PLWH
– How do they fit into the trial communities?
• Communities of health implementers
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Government health providers
NGO health providers
Community based organisations
Faith based organisations
Community and District Levels
Zambia
Implementation
Management
Team (Z-IMT)
Z-DIMT
Community
Advisory
Board
(CAB)
CBO reps
Community
stakeholder
reps
National
Community
Advisory
Board
(NCAB)
Opinion
leaders/ G
keepers
Community
partners
platform
National Level
Community Engagement
Zambia Trial
Management
Committee (ZTMC)
Dynamism
• Partnerships evolve
– First discussions with community and national health
authorities several years prior to trial being funded
– Discussions with all partners prior to submission of proposal
– Some partnerships develop more slowly than others, some
happen spontaneously, some have to be worked at
– Changing relationships as the trial progresses
• We may not all be natural partners
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Different language ( even if many of us use “English”)
Different cultures
Different skills
Different education and socio-economic status
Different power balances
Different expectations
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)
The HPTN 071 Study Team, led by:
Dr. Richard Hayes
Dr. Sarah Fidler
Dr. Helen Ayles
Dr. Nulda Beyers
Government Agencies:
Implementing Partners:
PEPFAR
Implementing
Partners
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