Reduction of Early Mortality among HIV-Infected subjects starting Antiretroviral Therapy (REMSTART) Trial PDF Print E-mail

This is a new multi-country randomised trial to be implemented both in Tanzania and Zambia in collaboration with London School of Hygiene and Tropical Medicine (LSHTM). It is financed by the European and Developing Countries Clinical trial Partnership (EDCTP). The study is expected to commence early 2012.

The trial will be conducted in urban centres in Tanzania (at the Care and Treatment Centre, in Mwanayamala, Dar-es-Salaam) and Zambia (University Teaching Hospital, Lusaka) in collaboration with partners from the Kenya Medical Research Institute, in Nairobi, the London School of Hygiene and Tropical Medicine, University College London, St Georges 35 Medical School London, Foundation for innovative new Diagnostics In Switzerland, Karolinska University Hospital, Sweden and the World Health Organisation. 

The project will address two research questions namely:

  • Can a complex intervention involving i) accelerated initiation of ART, ii) increased involvement of lay-workers in adherence iii) increased frequency of diagnostic testing for major co-infections lead to a reduction in early mortality among patients initiating ART compared to current standard of care.
  • Are home-based Voluntary Counseling and  Testing (VCT) for HIV and screening for tuberculosis among family members of subjects on ART feasible and cost-effective?

The specific objectives are:

  1. To determine the effects of the intervention, accelerated initiation of ART and enhanced monitoring, support and diagnostics just before and during the first 4-6 weeks of therapy, as compared with standard care. The primary endpoint will be all-cause mortality up to 12 months after enrolment into the study.
  2. To determine the costs incurred by the health service with this intervention strategy (in relation to standard care) and to relate these to the survival. To determine also the costs associated with accessing care for patients in the two arms of the trial.
  3. To determine the effects of the intervention on patient retention, hospital admissions,outpatient attendance as compared to standard care.


Last Updated on Thursday, 14 March 2013 14:18