Friday, June 18, 2021 6/18/2021

Can HIV Hot-Spots be eradicated? An intervention to decrease HIV transmission to young women in rural KwaZulu-Natal South Africa

Award Number: R01AI124389
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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¿ DESCRIPTION (provided by applicant): In two recent papers published in Science, we have demonstrated that public sector scale-up of ART in rural South Africa led to (i) large increases in adult life expectancy and (ii) significant declines in HIV infection risk, both measured at the population level (Bor et al. 2013; Tanser et al. 2013). And yet: HIV incidence and mortality rates remain unacceptably high in this HIV-endemic setting. In particular, young women (aged 15-30) remain at extremely high risk of HIV acquisition and more effective prevention programming is urgently needed for this group. Moreover, while the mass provision of free ART in public sector facilities in South Africa has dramatically reduced HIV-related mortality for both men and women, HIV-infected men are benefitting to a far lesser extent than women, because men are far less likely to link to HIV care. If the UNAIDS 90-90-90 targets are to be realized the gender gap in ART access has got to be closed. The two deficiencies in current HIV programs - continued high HIV incidence in women and comparatively low ART access in men - are inextricably linked. For successful treatment-as prevention, it is urgent that those large numbers of HIV-infected men - who are currently not benefitting from ART and who are infecting young women - are started on ART. Existing evidence and preliminary data from this community suggest that increased HIV testing and linkage to care can be successfully achieved through a combination of home-based HIV testing and financial incentives for both HIV testing and linkage to care. In this proposal we seek to reduce young female HIV incidence and male HIV-related mortality through a once-off, two-stage financial incentive to encourage HIV testing and linkage to HIV treatment in a real- world setting along. We will supplement this with some elements of motivational counselling and develop gender-sensitive approaches which draw on existing values and norms for men and for women. Following development we will implement the intervention in one third of the 42 communities contained in the Africa Centre's HIV surveillance area. Using a difference-in-differences design within an implementation science framework we will leverage the statistical power gained through a decade's long HIV surveillance and will compare the change in male viral load, male mortality and female incidence (15-30 years of age) pre and post intervention for residents of communities who receive and who do not receive the intervention respectively. Participants will then be followed up routinely through the Africa Centre's ongoing population-based HIV surveillance for three years. The results of this work will directly inform the development and targeting of prevention efforts in the context of generalized ART coverage.


Issue Date FY	Funding FY	Recipient Name	DUNS Number	City	State	CFDA Number	CFDA Program Title	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2020 ( Subtotal = $405,023 )
2020	2020	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	000	5	5/5/2020	NON-COMPETING CONTINUATION	$405,023


Issue Date FY: 2019 ( Subtotal = $1 )
2019	2019	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	001	4	6/13/2019	NON-COMPETING CONTINUATION	$1
2019	2018	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	000	3	4/3/2019	NON-COMPETING CONTINUATION	$0


Issue Date FY: 2018 ( Subtotal = $547,072 )
2018	2018	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	000	3	5/31/2018	NON-COMPETING CONTINUATION	$547,072


Issue Date FY: 2017 ( Subtotal = $586,387 )
2017	2017	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	003	2	9/26/2017	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$508,656
2017	2017	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	000	2	7/28/2017	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$586,387
2017	2017	KWAZULU NATAL RESEARCH INSTITUTE FOR TB-HIV	652889541	DURBAN 4013		93.855	Allergy and Infectious Diseases Research	001	2	9/23/2017	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2017	2016	UNIVERSITY OF KWAZULU-NATAL	637360244	DURBAN		93.855	Allergy and Infectious Diseases Research	002	1	9/26/2017	NEW	-$508,656


Issue Date FY: 2016 ( Subtotal = $534,300 )
2016	2016	UNIVERSITY OF KWAZULU-NATAL	637360244	DURBAN		93.855	Allergy and Infectious Diseases Research	000	1	5/5/2016	NEW	$534,300


Grand Total All Awards = $2,072,783

Sum of Action Amount is $2,072,783;

Grand Total = $2,072,783

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Can HIV Hot-Spots be eradicated? An intervention to decrease HIV transmission to young women in rural KwaZulu-Natal South Africa

Award Number: R01AI124389

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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