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EDCTP-funded project REMSTART finds new approach to HIV management to have reduced deaths by 28 per cent

10 March 2015

A new approach to caring for patients with advanced HIV which combined community support and screening for cryptococcal meningitis has reduced deaths by 28%. The research, published in The Lancet today, suggests that this low-cost intervention could be an effective approach to reducing HIV-related deaths in Africa.

Researchers from the REMSTART team – led by Dr Saidi Egwaga of the Tanzanian Ministry of Health and Social Welfare and Shabbar Jaffar, Professor of Epidemiology at the London School of Hygiene & Tropical Medicine – conducted a randomised trial of 1,999 HIV patients in Tanzania and Zambia between February 2012 and September 2014.

They enrolled patients who had advanced HIV disease and were beginning treatment. Most of the deaths in African HIV programmes occur in this group at around the time or just shortly after HIV treatment is started. All patients were firstly screened for tuberculosis and started quickly on HIV treatment. Patients were then given either standard care from a clinic, or given additional care which consisted of screening for cryptococcal meningitis as well as weekly home visits for the first four weeks from lay workers to support them with antiretroviral therapy.

The trial found deaths among patients receiving the additional screening for cryptococcal meningitis and home visits were 28% lower than those receiving standard clinic care (134 deaths and 180 deaths respectively over a 12 month follow-up period).

“This large trial was the first of its kind and the results are very exciting. The combination of screening and community lay worker support reduced the death rate among patients with advanced HIV by almost a third.”

Professor Shabbar Jaffar

Professor Shabbar Jaffar said: “The combination of screening and community lay worker support reduced the death rate among patients with advanced HIV by almost a third. About 10 million people in Africa are on antiretroviral therapy, but there is a disparity in the number of people who die in the first year of treatment compared to wealthier regions like Europe.”

“The screening for cryptococcal meningitis was also a significant component in the success of our trial. We now know that screening combined with giving pre-emptive treatment for this type of fungal meningitis is an effective strategy in reducing the high number of HIV deaths associated with it in Africa.”