The ITREMA project consists of a pragmatic randomized open-label clinical trial and several research studies and implementation projects linked to the clinical trial. Below is an overview of research output generated in the context of the ITREMA project.



Peer reviewed manuscripts

Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial Gumede SB, Wensing AMJ, Lalla-Edward ST, de Wit JBF, Francois Venter WD, Tempelman HA, Hermans LE. AIDS Behav. 2023 Jun 29. doi: 10.1007/s10461-023-04103-2. 

Point-Of-Care Tenofovir urine Testing for the Prediction of Treatment Failure and Drug Resistance During Initial Treatment for HIV-1 Infection Lucas E Hermans, Chijioke N Umunnakwe, Samanta T Lalla-Edward, Shane K Hebel, Hugo A Tempelman, Monique Nijhuis, Willem D F Venter, Annemarie M J Wensing. J Clinical Infectious Diseases. 2022 September 22

HIV-1 pretreatment drug resistance negatively impacts outcomes of first-line antiretroviral treatment Hermans LE, Hofstra LM, Schuurman R, Ter Heine R, Burger DM, Talboom SAJ, De Jong D, Tempelman HA, Venter WDF, Nijhuis M, Wensing AMJ. AIDS. 2022 Jun 1. Epub 2022 Feb 1.PMID: 35113046 Clinical Trial.;36(7):923-931. doi: 10.1097/QAD.0000000000003182

Improving viral load monitoring in South Africa: lessons from the ITREMA project de Vries L, Hermans LE, Nijhuis M, Schuurman R, Tempelman HA, de Wit J, Venter WDF, Wensing AMJ. HIV nursing matters volume 12, June 2021 pag. 8-11.

Clinical impact of pretreatment human immunodeficiency virus drug resistance in people initiating nonnucleoside reverse transcriptase inhibitor-containing antiretroviral therapy: a systematic review and meta-analysis Bertagnolio S, Hermans LE,  Jordan MR, Avila-Rios S, Iwuji C, Derache A, Delaporte E, Wensing AMJ, Aves T, Borhan ASM, Leenus A, Parkin N, Doherty M, Inzaule S, Mbuagbaw L. J Infect Dis. 2021 Aug 2

Point-of-care detection of nonadherence to antiretroviral treatment for HIV-1 in resource-limited settings using drug level testing for Efavirenz, Lopinavir, and Dolutegravir: a validation and pharmacokinetic simulation study Hermans LE, Nijhuis M, Tempelman HA, Houts T, Schuurman R, Burger DM, Wensing AMJ, Ter Heine R. J Acquir Immune Defic Syndr. 2021 Aug 1

Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries Frijters EM, Hermans LE, Wensing AMJ, Devillé WLJM, Tempelman HA, De Wit JBF. AIDS. 2020 Jul 15

Virological suppression and clinical management in response to viremia in South African HIV treatment program: A multicenter cohort study Hermans LE, Carmona S, Nijhuis M, Tempelman HA, Richman DD, Moorhouse M, Grobbee DE, Venter WDF, Wensing AMJ. PLoS Med. 2020 Feb 25

Drug level testing as a strategy to determine eligibility for drugresistance testing after failure of ART: a retrospective analysis ofSouth African adult patients on second-line ART Hermans LE, Steegen K, Ter Heine R, Schuurman R, Tempelman HA, Moraba R, van Maarseveen E, Nijhuis M, Pillay T, Legg-E’Silva D, Snyman T, Schapiro JM, Burger DM, Carmona S, Wensing AM. Journal of the International AIDS Society. 2020 June 9

Effect of HIV-1 low-level viraemia during antiretroviral therapy on treatment outcomes in WHO-guided South African treatment programmes: a multicentre cohort study. Hermans LE, M. Moorhouse, S. Carmona, D.E. Grobbee, L.M. Hofstra, D.D. Richman, H.A. Tempelman, W.D.F. Venter, A.M.J. Wensing.  Lancet Infect Dis. 2017 Nov 17. pii: S1473-3099(17)30681-3.

Conference papers

Increased risk of cART failure after low-level viremia under WHO guidelines. Hermans L, Moorhouse M, Carmona S, Grobbee D, Hofstra M, Richman D, Tempelman H, Venter W, Wensing A.  Oral presentation at the annual Conference on Retroviruses and Opportunistic Infections (CROI), Seattle WA, USA, 2017.


PI drug level testing as a screening tool for drug resistance in 2nd line ART failure. Hermans LE, Steegen K, ter Heine R, Schuurman R, Tempelman HA, Moraba R, van Maarseveen E, Pillay T, Legg-Esilva D, Schapiro JM, Burger DM, Carmona S, Wensing AMJ. Accepted for mini-oral poster presentation at the annual Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, 2019.


Impact of pretreatment drug resistance on treatment outcome in the ITREMA trial. Hermans LE, Hofstra LM, Schuurman R, ter Heine R, Tempelman HA, Venter WDF, Nijhuis M, Wensing AMJ.  Accepted for poster presentation at the annual Conference on Retroviruses and Opportunistic Infections (CROI), Seattle, USA, 2019.


Point-of-care drug level testing for adherence assessment of first and second line antiretroviral treatment in resource-limited settings Hermans LE, Nijhuis M, Kasper KC, O’Malley R, Oh SJ, Schuurman R, Tempelman HA, Venter WDF, Burger DM, Wensing AM, ter Heine R. . Poster presentation at the International AIDS conference, Amsterdam, The Netherlands, 2018.


High rates of viral resuppression on first-line ART after initial virological failure. Hermans L, Tempelman H, Carmona S, Nijhuis M, Grobbee D, Richman D, Moorhouse M, Venter W, Wensing A.  Poster presentation at the annual Conference on Retroviruses and Opportunistic Infections (CROI), Boston, USA, 2018.

Drug level screening to determine eligibility for drug resistance testing in South African patients with virological failure of second-line ART using Dried Blood Spots. LE Hermans, HA Tempelman, SR Moraba, R Schuurman, EM van Maarseveen and AMJ Wensing.  Oral presentation at the International Workshop on HIV Drug Resistance and Treatment Strategies – IWHDR, Johannesburg, South Africa, 2017.



The ITREMA project is funded bij ZonMw and supported by the African HIV Care & Cure (AHC²) Foundation and the Aidsfonds. ITREMA is a collaboration between investigators from the University Medical Center Utrecht (UMCU), Utrecht University, Radboud University Medical Center Nijmegen, the University of the Witwatersrand (Johannesburg, South Africa) and Ndlovu Care Group (NCG, Limpopo, South Africa).

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