Meet the CIPHER grantees

Alain Amstutz

Year awarded: 2018
Institution: Swiss Tropical and Public Health Institute
Research site: Lesotho, Butha-Buthe & Mokhotlong District, Lesotho
Primary mentor: Dr Niklaus Labhardt MD, DTM&H, MIH

Alain Amstutz is a physician researcher with a focus on clinical HIV research. He has been living in Lesotho for more than a year, and has fallen in love with the country and its people. His particular interest is in evaluating differentiated ART care/delivery models for high-burden and low-resource settings, such as Lesotho.

More information on Alain | Email

“The CIPHER grant enables me and my team to focus our clinical HIV research on one of the most burdened and vulnerable populations … It is a big honour becoming a grantee of such a renowned funding body and will provide me with a fundamental stepping stone in my career.”

Research project: GET ON IT (“GETting tOwards Ninety In Teens”): A two-part research project with one cluster-randomized controlled trial assessing targeted interventions to reach the UNAIDS 90-90-90 targets among adolescents and young adults living with HIV in rural Lesotho, Southern Africa

The issue

Lesotho, a small country landlocked by South Africa, has the second-highest HIV prevalence in the world, with adolescents and young adults one of the most affected groups. Adolescents and young adults are generally less likely to be tested, to be treated or to remain on treatment.

The CIPHER project

This project will test several innovative targeted interventions along the HIV care cascade for adolescents and young adults, and assess their potential effectiveness to reach 90-90-90 UNAIDS targets. It has two parts:

  • Part A (ADORE study) is a pragmatic implementation study assessing oral HIV self-testing (HIVST). HIVST shows promising results in specifically reaching adolescents and young adults for testing, as several experiences from the region have shown. However, data about its feasibility and potential during home-based HIV testing campaigns is scarce.
  • Part B (PEBRA trial) is a cluster-randomized controlled trial that evaluates the efficacy of a multicomponent youth-centred differentiated ART care model among adolescents and young adults living with HIV. The model involves decentralization of HIV care to community level by task shifting to peer educators and village health workers, psychosocial support through community youth clubs and the usage of an SMS intervention.

The impact

The intention of Part A is to fill a critical data gap in reaching the first 90 UNAIDS target (90% tested) for adolescents. The PEBRA model addresses the second and third UNAIDS targets (90% on treatment, and 90% remaining on treatment) in a manner that minimizes structural barriers (i.e., time-consuming, expensive ART refill visits) and increases care privacy using a youth-centred approach.