The advent of HIV unleashed huge increases in TB, particularly in Sub-Saharan Africa. TREATS
was conceived to explore whether a ‘universal test and treat’ intervention for HIV, known as
PopART, could reduce the number of people becoming infected with TB, and the overall
amount of TB in urban, high prevalence communities.
It was a unique opportunity to assess an intervention on a massive scale. It was made possible
through international collaboration with economists, statisticians, modellers, researchers,
technology companies, NGOs, TB experts and funders – the European & Developing Countries
Clinical Trials Partnership (EDCTP). As well as by the locally recruited staff who went door-todoor talking with individual households, and the communities who gave the project their trust
and support. KNCV has collaborated on the implementation of the Prevalence Survey of TREATS.
TREATS took more than four years from inception to completion, overcoming the suspension
of fieldwork caused by the Covid-19 pandemic. Crucially, it included social science elements
to improve understanding the impact of stigma, poverty and mental health on the experience
The key finding of the study was that the PopART intervention had no impact on the
prevalence or incidence of TB infection. The reasons why are complex and the research team
are in the early stages of analysing the results to identify possible explanations for the
Regardless, the study has shed light on the evolving relationship between HIV and TB now
that access to antiretroviral therapy has opened up to far more communities, notably in SubSaharan Africa. PopART and TREATS have shown how to carry out clinical trials and
interventions at scale among urban populations, building relationships with communities that
have sustained over several years.
TREATS has highlighted the central importance of addressing stigma around TB and HIV in
encouraging people to come forward for diagnosis and treatment, and has underscored the
impact of TB on mental health, driven by stigma and poverty. New methods of evaluation for
measuring the public health impact of TB interventions has important implications for future
fieldwork. African leadership in clinical research has been strengthened.
Above all, TREATS has shown that improvements in the diagnosis and treatment of HIV do not
easily translate into greater success against TB. Further research will be vital in building on
the lessons of TREATS to find the best ways to fight this devastating disease.