Is Total Community Viral Load a Robust Predictive Marker of the Efficacy of the TasP Strategy?

Abstract

A mild but significant association between a decrease in the total community viral load (CVL) and a decrease in the number of new HIV diagnoses was observed between 2005 and 2010 in the population of northern and eastern France. This result suggests that CVL could be used as robust marker of the efficacy of the "Treatment as Prevention" strategy, and it may even be stronger if a large number of undiagnosed patients and early HIV infection cases indicated by extend screening are included in the CVL measurement.

HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART

“…(…) I need to know my status. If I am HIV positive, I want to know, that I have to get treatment on the right time.” Similarly, Kabelo (39) said: “I want to know where I stand, even if I am positive I want to know, so that I can take care of myself before I get sick, because we normally leave it until we can’t get out of bed and we suspect it is this thing.”…”

“…Tlotliso (21) for instance mentioned that one of his partners, with whom he was having unprotected sex, had sex with a man who was HIV positive. Kabelo (39) said “We are human and we have sex and even with your partner you don’t always use condoms and you don’t know what he gets up to even though you are faithful.”…”

“…Otherwise it is a no-no.” A few men mentioned concrete physical symptoms, such as a rash, feeling sore, a cough, “a runny stomach,” or a fever as reasons to get tested for HIV. Kabelo (39) said he got tested when “me and my boyfriend stopped using condoms and I felt sick after that.” However, feeling sick would not always lead to getting tested. Probably unaware of symptoms of acute HIV infection, Danisa (25), who had never tested, said in response to the question whether there ever had been an instance that made him think that he must go test:

“There was a time that I was sick with flu for more than three weeks, then I thought ‘I need to go and test’ and suddenly my mind was changed.”

So you didn’t do it?

“I didn’t do it.”

But then this flu disappeared?

“And the flu disappeared and my mind was okay.”

…”

“…Playing down the impact, Amose (24) said for instance that he would “take it like flu” and Masopha (27) said that because there is medication, he did not view it as a death sentence. Kabelo (39) said he would be able to handle having HIV. HIV is not too much of a problem, he explained, because there is treatment; he was more concerned about dismissive responses from people, especially because the infection was through same-sex behavior: “People will say, ‘We have been telling him that sleeping with men is nonsense’.” Several men said that testing HIV positive would motivate them to lead a healthier lifestyle.…”

Incidences and risk factors of first-line HAART discontinuation: a limitation to the success of the “seek, test, treat, and retain” strategy?

“…Recently, it has also been argued that HAART could play a major role at the population level by decreasing the incidence of new HIV infections (Cohen et al, 2011;Henard et al, 2012;Montaner et al, 2010). Treatment may thus better "control" the epidemic; the new "seek, test, treat, and retain" strategy (STTR) fits into this logic.…”