Article

Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as a Strategy for Elimination of HIV Transmission: A Mathematical Model

Department of HIV/AIDS, WHO, Geneva, Switzerland.
The Lancet (Impact Factor: 45.22). 12/2008; 373(9657):48-57. DOI: 10.1016/S0140-6736(08)61697-9
Source: PubMed

ABSTRACT

Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination.
We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual.
The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. It could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1.7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.
Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.

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Available from: Reuben Granich, Sep 05, 2014
    • "Kwange and Budambula also demonstrated that there was no significant difference in sputum conversion rates at 2-and 5-months between HIV-negative TB patients and HIV-positive TB patients on ART[26]. Current research suggests that ART should be started early and preferably as soon as a person is tested positively for HIV[14,232425, and opposed to current recommendations to use CD4 count of 350–500 cells/mm 3 or less, or clinical staging of disease to determine who was eligible for ART[20]. However, as more and more HIV-positive patients are put on ART, there will be additional burden on already overburdened staff and more patients will be at risk of immune reconstitution inflammatory syndrome. "
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    • "Adherence to recommended HIV screening and laboratory monitoring in this high-risk population are crucial steps in the HIV continuum and will likely require the development of genderspecific services to more effectively engage WWUDs in HIV prevention and treatment to prevent HIV infection and transmission. HIV testing and monitoring is central to HIV treatment-as-prevention strategies (Granich et al., 2009; Montaner, 2013). Important in these findings are factors that may facilitate and impede treatment-asprevention efforts. "
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