Background
Recently published reports of a mathematical modeling exercise concluded, “Universal voluntary HIV testing and immediate ART (regardless of CD4 count) combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics” while two accompanying commentaries addressed how and whether this was feasible to deliver in the ‘real world’. The modeling exercise showed that HIV transmission could be substantially reduced within a few years. They argue that current clinical practice, which in nearly every setting relies on CD4 counts and advanced disease as the trigger to introduce ART, limits its preventive efficacy by leaving key points in HIV’s natural history - peak viral load at seroconversion and the sustained period of somewhat elevated viral load set point during the asymptomatic period - to go unchecked by effective viral load reducing treatment.

Since the release of these publications there have been calls for researchers to test empirically the concept that in populations universal voluntary HIV testing and immediate ART (regardless of CD4 count) combined with present prevention approaches can have a major effect on onward HIV transmission. Scientists at the Africa Centre, in collaboration with French colleagues are currently preparing a study protocol and funding application for the French Government’s ANRS, to undertake a community cluster randomized controlled trial across the Hlabisa health sub-district, in the communities beyond the Africa Centre’s demographic surveillance area (DSA). The trial will be delivered in a phased approach with a limited roll-out to approximately 25% of the total number of randomized clusters initial, with plans to scale up the trial within 18 months, should initial results suggest a large-scale effectiveness trial is warranted.

Research question
An initial social science study is being undertaken in advance of the trial. This preparatory work will focus on three areas: 1) community and individual understanding of the TasP concept; 2) the acceptability of different components of the TasP intervention package, for example, regular and repeated testing of HIV-negative participants, and 3) the requirement and the content of a community education package in preparation for the phased trial.

Data Sources
The preparatory study will use a combination of innovative qualitative methods, participatory action models and rapid assessment techniques. The main new data collection will involve a combination of individual in-depth interviews and consumer research panels. Both approaches can be useful to extend our understanding of the acceptability of the key elements of the TasP intervention package and to understand the community education and preparedness requirements. Unlike the individual in-depth interviews where the participant and researchers meet only once, a smaller number of consumer research panels will meet on several occasions. This allows for the panel to assume the role of expert advisors rather the more conventional focus group where participants are essential key informant. By combining this approach with participatory and action research techniques we will be able to collect sufficient key information quickly and with limited cost.