Grants signed in 2011
Reduction of early mortality among HIV-infected subjects starting antiretroviral therapy: a randomised trial (The REMSTART trial)

Project Coordinator: Saidi Egwaga
Institution: Tanzanian Ministry of Health and Social Welfare, Tanzania
Target disease: HIV
African countries involved: Kenya, South Africa, Tanzania, Uganda and Zambia
Cofunding partners: Karolinska University Hospital (Sweden), London School of Hygiene and Tropical Medicine (LSHTM, UK), Ministry of Health (Zambia), Ministry of Health and Social Welfare (Tanzania), Medical Research Council (MRC, UK) and WHO Tropical Diseases Research (Switzerland)
Budget: €3,774,390
Duration of project: March 2011-March 2014

The project will evaluate a health service strategy for reducing the high early mortality associated with antiretroviral therapy (ART) in Africa. The strategy involves accelerated initiation of ART when patients with very advanced disease present to clinic; increased involvement of lay-workers in adherence; and increased frequency of diagnostic testing for cryptococcal meningitis and tuberculosis. A simple and large trial “lean and mean” will be conducted. The primary objective of the trial is to determine the effects of the intervention, accelerated initiation of ART and enhanced monitoring, support and diagnostics just before and during the first 4-6 weeks of therapy, as compared with standard care. The primary endpoint will be all-cause mortality up to 12 months after enrolment into the study.