Safer, more robust and less expensive first-line antiretroviral therapy (ADVANCE trial)

A young woman receives antiretroviral therapy adherence counseling at a local clinic in South Africa Image: Wits Reproductive Health & HIV Institute

A rigorous clinical trial that could yield better first-line HIV treatment.


Current first-line regimens recommended in low and middle-income countries (LMICs) have successfully treated over 15 million people.

However, the regimens are highly susceptible to drug resistance, even in the event of a slight decrease in adherence. This results in rapid transition to more expensive and more complex second-line regimens.

In addition, first-line regimens prove toxic for a significant number of patients, compromising adherence.

Despite a strong need for better regimens in resource-limited settings, previous experience with transition to new antiretroviral (ARV) combinations in LMICs has shown that countries face significant challenges and delays in adopting new WHO recommendations, due to lack of effective planning and implementation.


This grant will conduct a rigorous clinical trial that could yield a new first-line regimen with the potential to transform healthcare for HIV-positive people in resource-constrained settings.

A large community-, clinician- and regulatory-engagement programme will run in tandem with the clinical trial to prepare South Africa and the region for this regimen.

This trial will evaluate a new first-line regimen that, if successful, will be cheaper, more tolerable for patients, and require a smaller dose than existing first-line regimens.  It will also aim to provide a far higher barrier to resistance.

“If we get this right, patients will benefit from safer, better tolerated, more forgiving and smaller tablets, while governments will save money. It is not often in medicine we get such a win-win.”
François Venter, Principal investigator, ADVANCE trial

Progress so far

The ADVANCE trial, co-funded by USAID, started screening in mid-January 2017, with enrolment completed on 17 May 2018. A total of 1,053 participants have been enrolled, and the study results are expected in 2020.

With support from this project, community and health-worker engagement and advocacy has scaled-up as South Africa plans to introduce dolutegravir into the national guidelines for antiretroviral therapy (ART) with estimated roll-out in early 2019.

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The impact we are seeking

The ultimate objective of this grant is to generate evidence that supports the wider adoption of optimal ARV regimens that are cheaper, more tolerable for patients, and have a smaller dosage than existing first-line regimens.
The significantly lower price of new therapies could enable the South African government to provide ART to several million more people with HIV by 2019 using the existing drug budget.

Link to related article: Cutting the cost of South African antiretroviral therapy using newer, safer drugs” – South African Medical Journal

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