Optimising clinical care strategies and laboratory monitoring for cost-effective roll-out of antiretroviral therapy in Africa: the Lablite project

How can HIV clinical care strategies and laboratory monitoring be optimised for cost-effective roll-out of Antiretroviral Therapy in Africa?

What is this study about?

Following on from the results of the DART trial this project aims to demonstrate, outside the context of a clinical trial, how treatment for HIV can be decentralised to lower-level health care centres in sub-Saharan Africa. The aim is to show that it is possible to increase coverage and access to treatment in a cost-effective manner in Uganda, Malawi and Zimbabwe. The project has 3 overall aims:

  • To map and describe delivery of training and clinical care , use of laboratories and treatment monitoring in HIV treatment centres through a survey of representative sites 
  • To demonstrate how decentralised strategies of clinical care and use of laboratories, informed by results from DART, would work in basically equipped health centres away from major hospitals
  • To assess the economic consequences of different ART delivery strategies– in particular the cost-effectiveness, budget impact, equity effects and health system implications of the delivery strategies for ART roll-out in Africa.

A cross-cutting area of work will be in communicating to influence policy.

Type of study

Observational study

Contact details

Who is funding the study?

UK Department for International Development.

When is it taking place?

The project will run from 01 May 2011 to 30 April 2014.

Where is it taking place?

Project Partners:

  • Joint Clinical Research Centre, Kampala, Uganda
  • MRC / Uganda Virus Research Institute, Entebbe, Uganda
  • Dignitas International, Zomba, Malawi
  • University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe 
  • MRC Clinical Trials Unit, London, UK 
  • Imperial College, London, UK 
  • Centre for Health Economics, University of York, UK

Who is included?

This is not a clinical trial – it is a project taking the results of a clinical trial and demonstrating they can be implemented, whilst subjecting them to rigorous evaluation and economic scrutiny. As such there will be no ‘recruitment’ to the trial. The demonstration sites will consist of 4 ‘hub and spoke’ referral systems (2 in Uganda, 1 each in Malawi and Zimbabwe) for HIV-infected adults and children. The ‘hub’ is a larger, better equipped, probably urban referral centre, and the ‘spokes’ are more basic centres with limited or no lab facilities, but which are nearer to where people live. These sites have not previously been involved in research; some will be sites new to delivering treatment services to HIV-infected individuals.