Grant: Applied Public Health Chair - LOI

Antiretroviral treatment (ART) can virtually halt HIV from reproducing, drastically reducing the amount of circulating virus in a person's body. In controlled clinical trials, ART reduces the risk of HIV transmission between heterosexual couples by more than 95%. The primary objective of this research is to evaluate the impact of a population-based intervention of HIV testing, care and treatment on new HIV infections in a high HIV burden region of East Africa. The primary anticipated outcome of this public health intervention is a reduction in new HIV infections. Since 2001, the Academic Model Providing Access to Healthcare (AMPATH) program, headquartered in Eldoret, Kenya, has enrolled >150,000 HIV-infected patients and is currently caring for over 80,000. AMPATH has already conducted widespread door-to-door HIV testing in several of its catchments. Now, in these same catchments, it is moving to test/re-test (Find) >95% of all eligible adults and children, Link to care >80% of those found to be positive, Treat 100% of those linked who are eligible according to current treatment guidelines (plus 100% of individuals in HIV discordant relationships), and Retain 95% of those treated. The intervention, called FLTR (Find-Link-Treat-Retain) targets the general population of these catchments in western Kenya as well as Most At-Risk sub-Populations within them including youth, pregnant women, and adult men (all are at high risk of acquiring HIV and/or of less equitably accessing HIV prevention, care, and treatment services). The proposed program of research is aligned with several of the priorities identified by the Canadian Institutes of Health Research and particularly the Community-Based Primary Health Care (CBPHC) Signature Initiative. Knowledge generated from the processes and outcomes of this work may be highly relevant to other communicable and chronic disease issues and to high-risk situations in Canada and elsewhere.