ICAP at Columbia University's Mailman School of Public Health is the recipient of three awards from the U.S. Agency on International Development that will support implementation science studies in Lesotho, Mozambique, and Swaziland over the next three years. The studies will test uniquely designed interventions that aim to evaluate the feasibility and impact of HIV programs in low-resource settings, and are a part of a larger implementation science initiative supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). ICAP is conducting the studies in partnership with ministries of health and local health care management teams, ensuring that the studies are locally appropriate, and findings are relevant and generalizable in study settings and similar contexts.
The first study, which takes place in Lesotho, builds on the several years of ICAP’s partnership with the Lesotho Ministry of Health and Social Welfare to enhance and strengthen the tuberculosis (TB) control program and TB/HIV integration at the national, district, health facility, and community levels. Among people living with HIV, tuberculosis (TB) is the most common opportunistic illness and a leading cause of death, accounting for nearly a quarter of HIV-related deaths worldwide. The new USAID-funded study will support ICAP’s Project START (short for Start TB patients on ART and Retain on Treatment). Project START will evaluate the effectiveness and acceptability of a package of interventions that seeks to improve early initiation in HIV and TB treatment and retention among HIV-infected TB patients receiving care at integrated TB/HIV clinics in one district in Lesotho.
The second award is for a research study in Mozambique called Engage4Health. This study will test the effectiveness of a multipronged intervention that aims to improve retention of HIV patients over 12 months. Keeping these patients in treatment as they move from HIV testing sites to treatment sites and helping them maintain their commitment to drug treatment are essential to promoting the health of those living with HIV and preventing HIV transmission. The intervention will include point-of-care CD4+ count assays at HIV testing sites, accelerated initiation of HIV treatment for eligible patients, and appointment reminders sent via text messages.
Mozambique has an estimated 1.7 million people living with AIDS and approximately 120,000 people infected annually. ICAP has been one of the major PEPFAR implementing partners in the country since 2004, and has worked collaboratively with the Mozambique Ministry of Health to provide technical assistance and financial support for the scale-up of HIV prevention, care, and treatment in four provinces, including in Maputo and Inhambane, where project activities will be focused.
A third study in Swaziland will evaluate a prevention of mother-to-child transmission (PMTCT) intervention that tests a new approach to treating pregnant women with HIV. The study entitled “Situkulwane Lesiphephile—Safe Generations” will test a modified approach to the current PMTCT options included in the World Health Organization guidelines. “Option B+” involves initiation of lifelong HIV treatment regardless of the mother's CD4+ count (a measure of disease severity) and engages all pregnant and postpartum women and their infants in structured appointment and follow-up protocols to help increase compliance. Currently, these protocols are in place only for non-pregnant women receiving treatment.
In Swaziland, approximately 40% of pregnant women are HIV-infected, and reports from 2011 indicate that access by such women to HIV treatment during pregnancy remains sub-optimal. It is hypothesized that this single, streamlined treatment and retention approach for all HIV positive women could result reduce the transmission of HIV from mother to infant and lend itself to cost-effective scale-up. The proposed evaluation will study 3,200 HIV positive women in 12 high-volume primary care facilities in Swaziland.
“Implementation science research is essential to improve service delivery and health outcomes and address critical gaps,” said Wafaa El-Sadr, MD, MPH, ICAP director and Mailman School Professor of Epidemiology and Medicine. “These studies offer the promise of identifying practical, feasible, and effective options for HIV programming, with the ultimate goal of ensuring the wellness of individuals, families, and communities.” ICAP director and Mailman School Professor of Epidemiology and Medicine. “These studies offer the promise of identifying practical, feasible, and effective options for HIV programming, with the ultimate goal of ensuring the wellness of individuals, families, and communities.”