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Essex M.
JAIDS Journal of Acquired Immune Deficiency Syndromes: January 2016
doi: 10.1097/01.qai.0000479591.05474.3d
Abstract: PDF Only

The BCPP is one of several large trials in Africa designed to test the value of antiretroviral (ARV) drugs to prevent transmission of HIV. Based in Botswana, the trial involves about 100,000 adults aged 16–64. It is a pair-matched, community-randomized design covering 30 villages with an average population of 6,000. The primary goal is reduction of 36-month cumulative incidence for the 15 villages that receive the prevention interventions, which include 3-drug ARV to all adults with viral load (VL) ≥10,000 and/or CD4 ≤500. A baseline household survey (BHS) is conducted in 20% of randomly selected households in all 30 villages to establish a cohort to monitor incidence. Viral genetic linkage (VGL) was used to refine the analysis of incident infections to estimate the fraction that likely originated within each intervention village, as TasP can only prevent infections that originate in the site where it is used. We have developed procedures using VGL with full-length genomes and different sampling densities to estimate clustering according to village of origin in BCPP. BHS sampling also revealed that Botswana has a very effective national ART program. In response to UNAIDS 90-90-90 goals, the first is the fraction of HIV-positive people who already know they are positive. For Botswana, the best estimate for this is 81%. Using the same BHS data, about 86% of people who know they are positive are already on treatment, and 96% of those on treatment were in complete viral suppression. This results in a score of 67%, already close to the 2020 goal of 73%.

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