Optimising HIV treatment in low income countries

In high income settings, doctors use regular laboratory tests to monitor the effectiveness of the medicines, but these are expensive and inaccessible to people living in low income or rural settings.

Professor Diana Gibb, from the MRC Clinical Trials Unit at University College London, wanted to find out how best to use ART medicines in Africa to treat people as safely, effectively and easily as possible where laboratory testing is not available. In 2005, when Diana was conducting her research, just 17 per cent of people who needed treatment were receiving ART in sub-Saharan Africa.

Diana led two trials, known as the Development of Antiretroviral Therapy in Africa (DART) and Anti-Retroviral Research for Watoto (ARROW), in 2003 and 2007 respectively. Funded by the Medical Research Council (MRC), they investigated the best treatment approaches for HIV in Uganda and Zimbabwe, with DART focusing on adults, and ARROW focusing on children.

These studies, involving over 3,000 adults and 1,200 children, drew very similar conclusions.

“Our research showed that ART medicines can be delivered safely and effectively by healthcare workers, in communities where routine laboratory services are not available”, says Diana. “We also recommended that HIV programmes focus their resources on getting more people on to life-saving treatment – an approach that had the potential to save many more lives.”

To help Diana communicate her findings, we awarded almost £60,000 of research funding as part of our Changing Policy and Practice Award.

The discoveries from DART were transformed into a short film, which was featured multiple times on BBC World during World AIDS Day in 2009 and during the 2010 British Science Festival. Diana and her team also hosted a formal event to launch the project’s briefing document in Westminster, which was attended by more than 120 people from a wide range of organisations.

ARROW was communicated to national policymakers in the Ministry of Health in Uganda and Zimbabwe, and paediatric HIV treatment-implementing organisations, to inform their decisions on how to treat children with HIV in Africa. Evidence from the trial also helped to inform the World Health Organization’s guidance on cotrimoxazole treatment.

Diana also produced a series of 20 case study training videos to help health workers across Africa treat children with HIV more effectively, which have been distributed to around 200 teachers at medical schools in 20 African countries.

“The Foundation’s support enabled us to share the results of our trials with policymakers and clinicians globally,” says Diana.

“Without this funding, we would not have been able to produce or distribute these tools, making it harder for clinicians to learn and apply the results from our trials.”