# A Multisectoral Strategy to Address Persistent Drivers of the HIV Epidemic in East Africa

> **NIH NIH U01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2022 · $4,681,869

## Abstract

Project Summary
Progress towards HIV elimination will stall unless we overcome persistent drivers of new HIV infections by
jointly optimizing HIV treatment and effectively delivering HIV prevention modalities. We aim to determine how
to reduce HIV incidence to <0.1% using innovative strategies for HIV prevention and treatment to concurrently
reach “persistent driver” populations with scalable interventions optimized and evaluated in two phases.
• In Phase A (years 1-2), we will conduct individually randomized controlled trials (RCTs) to optimize the
 following prevention and treatment packages: 1) Dynamic Choice HIV Prevention with flexible Pre-
exposure/post-exposure prophylaxis (PrEP/PEP) access integrated at family planning, antenatal care and
HIV clinics and at community Youth Hubs that generate demand by also offering provision of life-skills,
micro-finance and vocational training. 2) Dynamic Choice HIV Treatment with individual and system care
 options and services tailored for youth, men, mobile populations, and heavy drinkers.
• In Phase B (years 3-5), we will test the hypothesis that a multi-sector intervention, offering dynamic choice
of biomedical HIV prevention and treatment for persistent driver populations will increase viral suppression
 and prevention coverage and lead to a reduction in HIV incidence greater than standard of care.
Aim 1: Optimize dynamic prevention and treatment interventions: We will conduct RCTs of PrEP/PEP
dynamic prevention at multiple venues with high risk populations, and dynamic treatment interventions for
multiple populations with unsuppressed viral load. Primary efficacy outcomes (HIV prevention coverage and
viral suppression) will be used with implementation outcomes, costing, modelling projections, and stakeholder
input to optimize dynamic prevention and treatment intervention packages for Phase B.
Aim 2: a) Compare the effect of Dynamic Choice Prevention and Dynamic Choice Treatment
interventions vs. standard-of-care on prevention coverage, viral suppression, HIV incidence and
community health outcomes at 3 years. We will use a community randomized 2x2 factorial design to identify
effect of each intervention package and their combination on prevention coverage, viral suppression, and other
health outcomes. b) Elucidate pathways of intervention impact via evaluation of implementation and
process outcomes and of socio-behavioral pathways of action at the community, clinic, and individual levels.
Aim 3: Determine sustainability and inform policy. We will conduct multi-site costing of each aspect of the
multi-component intervention and estimate costs per HIV infection averted and impacts on multi-disease
disability-adjusted life-years (DALYs). Modelling incorporating study data will be used to inform stakeholders
on anticipated long-term health impact and costs of alternative prevention and treatment strategies.
Significance: This study will address major knowledge gaps on how to overcome key factors fueli...

## Key facts

- **NIH application ID:** 10438844
- **Project number:** 5U01AI150510-03
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Diane V Havlir
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $4,681,869
- **Award type:** 5
- **Project period:** 2020-09-25 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10438844

## Citation

> US National Institutes of Health, RePORTER application 10438844, A Multisectoral Strategy to Address Persistent Drivers of the HIV Epidemic in East Africa (5U01AI150510-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10438844. Licensed CC0.

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