PopART intervention rolls out into communities
PEPFAR-funded study aims to find out whether offering a combination of several HIV prevention methods to a community will better prevent the spread of HIV than the standard methods that are offered individually today in both South Africa and Zambia.
The Desmond Tutu TB Centre, Stellenbosch University of Cape Town, South Africa, is rolling out a combination prevention package for the HPTN 071 (PopART) Population Effects of Antiretroviral Therapy to Reduce HIV Transmission study. PopART – as the study is referred to – aims to find out whether offering a combination of several HIV prevention methods to a community will better prevent the spread of HIV than the standard methods that are offered individually today.
The study is being conducted in South Africa and Zambia and the combination prevention package is rolled out as a randomized control trial with three study arms. The three study arms are:
- Arm A: communities will receive all of the PopART Intervention package components. Members of the communities will be immediately eligible for HIV treatment.
- Arm B: communities will receive all of the PopART Intervention package components, except HIV treatment will only be offered to those eligible according to national guidelines.
- Arm C: communities will continue to receive the current standard of care in the country.
The President’s Emergency Plan for AIDS Relief (PEPFAR) has provided the funding through the Centers for Disease Control and Prevention (CDC), South Africa, to roll out the PopART Intervention into the communities. To deliver the services of the PopART Intervention package, over +270 CHiPs (Community HIV Care Providers) were trained on home-based HIV counselling and testing, HIV rapid test finger pricking, the HPTN 071 (PopART) protocol, and a modified version of Good Clinical Practice for field staff.
Mrs Gaynore Leteshia Antas Pieterson was hired and trained as a CHiP to conduct home-based HIV counselling and testing. Due to her dedication to her work and commitment to her community, she moved up in position from a CHiP into a Field Supervisor who now manages a team of 14 CHiPs in the community. “When I was a CHiP the Desmond Tutu TB Centre encouraged us to always do our best so that you can develop your skills because there are always opportunities to grow, so I was motivated in such a way that eventually I worked hard as CHiP and moved up in position to become a Field Supervisor later down the road,” says Mrs Pieterson.
Her daily work comprises of ensuring the field teams have the support needed for delivering the services of the PopART Intervention package into the community. She conducts home evaluations of the CHiPs’ performances and provides feedback for improvement. Mrs Pieterson believes CHiPs are making an impact in the community, “CHiPs are really helping the community in so many ways. They are bringing the clinic to the community and to the houses. They are taking away stigma by delivering the PopART Intervention package to everyone. They support community members who are HIV positive and even those that test negative. Sometimes just by listening to a client it really makes a change, so they are of great help to the community.”
The field staff that are hired are from the local community, so they are also facing the day-to-day challenges that arise in the townships. Mrs Pieterson says, “I have gone through difficult times but I always remember what my colleague said to me ‘If you plant your seeds, water your plants, take care of your environment, tend to your plant daily, you will reap good fruit’ and that has helped me remind myself to continue to work hard.”
According to Mrs Pieterson, there are challenges to direct service delivery into the communities as the field staff have had to adjust to working evening and weekend hours to reach people that are not home during normal working hours, and the challenges of managing such a large group of CHiPs who are spread across the community, yet she still felt very proud to be in the role that she is in currently, “The Desmond Tutu TB Centre gave me an opportunity to empower myself.”
The PopART Intervention package (HIV combination prevention methods) includes:
Offering universal voluntary HIV testing to everyone in the community, delivered through door-to-door, home-based testing;
- Referring those who test HIV positive through PopART, or those already living with HIV but not on ART, to HIV care at their local health clinic;
- Offering ART earlier than current national guidelines (in Arm A sites);
- Offering men who test HIV negative access to professional medical male circumcision providers;
- Promoting treatment for pregnant women with HIV, to prevent them from passing HIV to their babies;
- Referring people with sexually transmitted infections to be treated at their local health clinic; and
- Providing condoms in the community.