Grant: Operating Grant

Human Immunodeficiency Virus (HIV) is a threat to global health and economic stability. In spite of ongoing prevention efforts, such strategies have had limited success in decreasing the number of new infections. Combination Antiretroviral Therapy (cART) is a successful multi-drug therapy for reducing illness and death among those receiving it. CART reduces the amount of virus in the body and has been successfully used to prevent mother-to-child transmission of the infection. We aim to determine if expanded cART use in populations with a high level of HIV infected people can reduce the number of new infections in the community. The scientific logic behind this is that successful treatment of an individual will make them less infectious to their sexual partners. We will sample many households in the Bushenyi and Gulu districts of Uganda. With our implementing Ugandan partners, The Joint Clinical Research Centre, we will conduct ongoing HIV testing and collect sexually transmitted infection (STI) data on consenting adults (15-59). We will conduct a yearly survey with participants addressing risk factors. We will dramatically scale-up cART access in these districts using a novel design called a 'step'wedge' design that allows us the increase access to specific populations at specific time points. We will measure incidence of STIs and HIV on a yearly basis and determine if there is a lower number of new infections with expanded cART use. We will determine if new infections are caused by individuals receiving treatment or by high-risk individuals.We will survey the population about HIV risk factors. This study will provide strong inferences about the use of cART to prevent new HIV infections. It will identify infected individuals early and provide clinical care to them. Finally, it will provide strong inferences on risk factors for HIV/AIDS in these communities.