1. The DART Trial Evaluates two strategies for delivering ART, comparing: clinical monitoring only with routine laboratory + clinical monitoring structured treatment interruptions with continuous ART

2. Trial features I 5 year trial 3 sites: Harare, Kampala, Entebbe 3000 patients – 1000 at each site / 1 year Primary endpoints : Efficacy -progression to a new WHO stage 4 or death Safety - new SAE which is not HIV related Other outcomes: Adherence, Virological including resistance, Socioeconomic & behavioural impact

3. DART Entebbe Collaboration with TASO and Entebbe Hospital DART Clinic at Entebbe Hospital – MOH Care services: Counseling Diagnosis of HIV related illness & OIs Treatment of HIV related illness & OIs Antiretroviral therapy & monitoring Psychosocial support

4. Funding Sources Medical Research Council, UK Rockefeller Foundation, USA Department for International Development, UK Rock House Foundation, UK

5. Drugs Anti-retroviral drugs donated by Boehringer-Ingelheim- Nevirapine Gilead- Tenofovir GlaxoSmithKline- Combivir

6. Trial Review Process 2 yrs + Risk benefits fine Most attention to end of trial issues Concern about exclusion of pregnant women ? What happens after patient 1000 - community Very little discussion on ability of participants to decline

7. Trial Approval UVRI Science & Ethics Committee Uganda National Council for Science & Technology - granted research clearance Ethics committees in Zimbabwe & UK Support letter from MOH

8. Trial Monitoring Trial Steering Committee International Co-ordinating Group Local Trial Management Committees Analysis & Data Management Committee Data & Safety Monitoring Committee Pharmaceutical companies - adverse events End Point Review Committee

9. International Coordinating Group PI’s Dr Peter Mugyenyi - Kampala Prof Jimmy Whittworth - Entebbe Prof Ahmed Latif - Zimbabwe Prof James Hakim - Zimbabwe Prof Janet Darbyshire - London Prof Charles Gilks - Geneva Site investigators Dr Diana Gibb - London Dr Andrew Reid - Zimbabwe Dr Cissy Kityo - Kampala Dr Paula Munderi - Entebbe Plus Dr Dorothy Bray - Consultant Dr Alex Coutinho - TASO Uganda

10. Other ART Trials in Uganda 1992 JCRC Determining the lowest effective dose of AZT 16 weeks duration 1 yr therapy to participants post trial

11. Other Trials……………. 2002 Care project ( Pharmaccess, GSK, Roche ) Uganda, Kenya, Senegal, Cote d’Ivoire Response, Side effects, Education & adherence 200 participants total, 50 in each country Will provide ART to participants post trial

12. Other Trials…………….. 2003 JCRC - NIH Evaluation of short STI strategies ( 7 days on 7 days off / Weekend off ) 171 participants to date Clinical follow up and monitoring provided Patients pay for own ART but save on drug cost ( 50% 7 days ; 30% weekend)