Case Control Studies – #2

Evaluation of Universal HIV treatment in the PopART Study

A second Case Control study (CC2) nested under the on-going HPTN 071/PopART trial started on October 19, 2015 following the conclusion of the first Case Control studies which began earlier this year. CC2, is the fifth sub-study to be conducted under PopART, and will specifically examine linkage to care and starting of Anti-retroviral Therapy (ART), among people who were found HIV positive during the first year of home-based PopART intervention delivered house-to-house by the Community HIV Care Providers (CHiPs).
The study will be rolled out progressively in all Arm “A “sites where HIV positive clients are required to be initiated on ART regardless of their CD4 count. The cases for CC2 study were randomly selected to represent the wider community in order to help researches understand the factors associated with uptake and non-uptake of ART within 6 months of referral by the CHiPs.
CC2 will explore the factors in the cases (patients who did not start ART within 6 of referral by the CHiP) and compare with the factors in the controls (those who started within 6 months). As it was observed in the first years of the PopART trial , not everyone that tested HIV positive accepted the referral to start  ART, as part of the PopART combination HIV prevention package, and which is key in the test and treat approach.
“By looking at the differences between the two groups of the cases and controls, researchers will get insight into the factors that influence HIV positive clients into accepting and not accepting to start ART as part of UTT. In addition, it will allow them to make recommendations that would facilitate in getting those people who do not accept the referrals by the CHiPs to start ART. These recommendations may help to improve the annual rounds 2 and 3 of the CHiPs referrals and linkage to care in order to achieve the overall PopART goal of Universal Test and Treat,” said Dr Kalpana Sabapathy, CC2 manager and Clinical Epidemiologist working on the PopART trial.
Dr Sabapathy, said CC2 may also provide recommendations that can improve linkage to care and ART care services at the government ART centres. Case Control 2 will run for the period of 3 months and will involve 480 people in Zambia and 360 in South Africa.
Evaluation of Universal HIV Testing in the PopART Study
Meanwhile, the first Case Control study which started on February 6, 2015, wound up on August 30, 2015. The study examined factors associated with uptake and non-uptake of home-based HIV testing offered to door by the CHiPs.
503 participants consented to participate in the study and were interviewed by the Case Control Research Assistants (RAs).
During CC1, the CHiPs and CC RAs Encountered various challenges which included difficulties in finding participants at home; demand for incentives to participate in the study by some participants, limited knowledge of CC1  by the CHiPs and hence  difficulties encountered when obtaining verbal permission from the participants. Other challenges experienced by the CHiPs were in meeting their daily intervention goals on the days of tracing CC1 participants and locating participants who were reported to have shifted from one zone to another, but within the community. Currently, the researchers are working on data analysis and report writing.