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Rolling out HIV Treatment in Africa? ARVs or Lab tests – which come first?   The DART and ARROW Trials.

Christine walked 60km the day after giving birth to get HIV treatment for her and her baby.
 

Anti-Retroviral Therapy (ART) is a package with many components, some of which are easier to deliver than others in rural areas of Africa, which lack health infrastructure and clinical laboratories. The DART and ARROW trials pioneered the use of ART on the continent, testing whether one could roll out the ARVs without all the expensive lab tests done in wealthy countries. With more than 3000 participants DART was one of the largest HIV treatment trials done in Africa.

A Trial for Life, about the DART Trial, tells the moving stories of the first generation to receive free ART. Many were close to death when they joined the trial. It is narrated by Annie Katuregye, one of the trial participants; so the science behind Randomised Controlled Clinical Trials is told from the point of view of those taking part. The film also features the story of Christine, who walked 60 kilometres the day after giving birth, to get to the nearest clinic offering treatment, because she knew she was HIV positive and wanted to protect her baby. She tells of others in her village who died because they were too sick to make the journey.

Together the trials provide strong evidence that Anti-Retroviral medicines are safe and effective and will keep patients healthy, without the expensive routine laboratory tests used in many HIV programs to monitor treatment. This today remains highly relevant in Africa, where resources are severely stretched and where the HIV epidemic is most severe in rural areas without laboratory infrastructure. The results show prioritizing treatment for everyone who needs it close to where they live, before investing in expensive lab tests, would save many more lives.

A Trial for Life – The Story of the DART Clinical Trial (2009, 55 Mins)

This full length documentary tells the story of participants in a major clinical trial designed to test faster strategies to roll out HIV treatment to Africa. Many were the first in their communities to receive Anti-Retroviral medicines, and were close to death when they joined the Trial. The DART results are still relevant today in trying to work out treatment priorities in countries were resources are very limited.

The DART Clinical Trial summary (2009) – 2’43”

A short summary of the results of the DART trial.

Lessons of the DART Clinical Trial (2009, 10 Mins)

DART provided good quality evidence that it would be safe to roll-out of HIV medicines to rural Africa, without the expensive routine lab tests used to monitor treatment in wealthy countries. This film, aimed at policy makers, summarises the findings of the Trial, which followed more than 3000 people over five years in Uganda and Zimbabwe.

The ARROW Clinical Trial. Clinical vs Lab monitoring in HIV+ children. (2014, 8 mins)

Arrow followed 1200 children over five years in Uganda and Zimbabwe. The results mirrored those of the DART trial, strongly suggesting that prioritising ART roll-out in rural Africa would save more lives than prioritising laboratory monitoring for those already on treatment.

The ARROW Clinical Trial. Cotrimoxazole helps HIV+ children say healthy in the long term. (2014, 6 mins)

A second question of the ARROW Trial confirmed that the long term use of cotrimoxazole helps keep children out of hospital, even after their health has been restored by Anti-Retroviral therapy. The film shows how continuing the prophylaxis is a cost effective and beneficial policy.