HPTN 043 “Project Accept” Study Published in The Lancet Infectious
Diseases Demonstrates that Community Mobilization Boosts HIV
Testing Rates in Developing Countries
Wednesday, 4 May 2011
The addition of community mobilization activities and support services to a mobile HIV
counseling and testing program can greatly improve the rates of initial and repeat testing in
remote rural communities, according to new research supported by the HIV Prevention Trials
Network (HPTN) and the National Institute of Mental Health (NIMH).
Results from the “Project Accept” study (HPTN 043), conducted in rural communities in
Tanzania, Zimbabwe, and Thailand, were published today online in The Lancet Infectious
“Knowledge of HIV status is an important gateway to prevention and treatment services. This
study answers the question of how best to scale up testing in resource-limited settings,” says
Quarraisha Abdool Karim, HPTN co-principal investigator and associate scientific director of
CAPRISA. “It shows HIV testing becomes more accessible through a community-based approach.
In developing countries, most people infected with HIV do not know their infection status.”
"An essential component of any prevention effort is to combine interventions both for HIV-
infected and uninfected persons,” adds Sten Vermund, HPTN co-principal investigator and Amos
Christie Chair of Global Health at the Vanderbilt University School of Medicine. “The NIMH
Project Accept/HPTN 043 team has demonstrated that a radical increase in testing acceptance is
feasible in highly diverse rural and urban settings in both Africa and Asia. This vital clinical trial
discovery gives us hope that prevention and treatment programs can reach people who know
their HIV status."
HPTN 043 is the first international randomized controlled Phase III trial to determine the efficacy
of a community-level intervention with an HIV incidence endpoint. Communities in each setting
were paired according to demographic characteristics, and one of each pair was then
randomized to receive either clinic-based voluntary counseling and testing alone or a
Sweat M, Morin S, Celentano D, et al. Community-based intervention to increase HIV testing and case detection in
people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised
study. Lancet Infectious Diseases; published online May 4, 2011
combination of clinic-based testing and community-based testing. The community-based testing
included mobile HIV testing along with community mobilization and post-test psychosocial
support services. The results of the impact of this intervention on new HIV infections will be
available in 2012.
The researchers found that the proportion of persons who received their first HIV test during
the study was higher in areas that received the “combination” testing than in those areas that
received “stand-alone” clinic-based testing in Tanzania (37 percent vs. 9 percent), Zimbabwe (51
percent vs. 5 percent), and Thailand (69 percent vs. 23 percent).
Although the HIV prevalence rate was higher in the stand-alone testing areas than in the areas
that received combination testing, the programs in the combination-testing areas detected
almost four times more HIV cases (952 vs. 264) because they were able to test a greater number
of people. Repeat HIV testing in areas that received the combination testing increased at all
sites, reaching 28 percent of all those who were tested by the end of the intervention period.
Previous studies have shown that men are often difficult to reach with HIV prevention services.
In this study a larger proportion of male clients received HIV tests in the combination-testing
areas compared to the stand-alone testing areas. Few clients tested for HIV infection as couples
in Tanzania and Zimbabwe but the proportion of clients who tested as part of a couple in
Thailand was much higher than it was at other sites.
“Communities can be mobilized to learn their HIV infection status, including in remote rural
communities with little infrastructure across different regions, epidemic settings, and cultures,”
said HPTN Protocol Chair of the study, Thomas Coates, professor of medicine and director of the
University of California, Los Angeles (UCLA) Program in Global Health. The trial demonstrated
that “local communities respond to HIV epidemics when comprehensive, user-friendly services
are provided,” he added.
HPTN 043 is a Phase III trial testing the feasibility of a community-wide HIV counseling testing
approach to prevention, using HIV and incidence as an endpoint in Tanzania, Thailand, and
Zimbabwe. The trial is funded by the National Institute of Mental Health, and is supported by
the HIV Prevention Trials Network. Additional support has been provided by the Office of AIDS
Research of the National Institutes of Health.
HIV Prevention Trials Network
The HIV Prevention Trials Network (HPTN) is a partnership between scientists and communities
around the world to develop, evaluate, and implement cutting-edge biomedical, behavioral, and
structural interventions to reduce the transmission of HIV. HPTN uses randomized controlled
clinical trials, designed and conducted according to the highest scientific and ethical standards,
to identify the best combinations of interventions for the populations at highest risk of HIV
For more information on HPTN, see www.hptn.org