DART and ARROW clinical trials: HIV priorities for Africa

Rolling out HIV Treatment in Africa? ARVs or lab tests – which come first?

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.

Our film ‘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. Today, this 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.