Treatment as prevention: preparing the way

Abstract

Potent antiretroviral therapy (ART) reduces mortality and morbidity in people living with HIV by reducing viral load and allowing their immune systems to recover. The reduction in viral load soon after starting ART has led to the hypothesis that early and widespread ART could prevent onward transmission and therefore eliminate the HIV epidemic in the long term. While several authors have argued that it is feasible to use HIV treatment as prevention (TasP), provided treatment is started sufficiently early, others have reasonably drawn attention to the many operational difficulties that will need to be overcome if the strategy is to succeed in reducing HIV transmission. Furthermore, international public health policy must be based on more than theoretical studies, no matter how appealing. Community randomized controlled trials provide the gold standard for testing the extent to which early treatment reduces incidence, but much still needs to be understood and the immediate need is for operational studies to explore the practical feasibility of this approach. Here, we examine some of the issues to be addressed, the obstacles to be overcome, and strategies that may be necessary if TasP is to be effective. Studies of this kind will provide valuable information for the design of large-scale trials, as well as essential information that will be needed if early treatment is to be incorporated into public health policy.

Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa

“…To achieve the 90-90-90 goals in a country like South Africa, this approach—labeled “seek, test, treat, and retain” (STTR) [8]—will require expanding STTR efforts among people who use alcohol and other drugs, female sex workers, and men who have sex with men [9, 10]. …”

Estimating the Number of Young Black Men who have Sex with Men (YBMSM) on the South Side of Chicago: Towards HIV Elimination within US Urban Communities

“…9,10 However, many operational difficulties will need to be overcome. 11 By providing a population estimate of the number of YBMSM on the SSC, we will aid HIV prevention program planning efforts by establishing a denominator for a measurable objective. Three methods were used to estimate the population: an indirect approach, 12 a representative population survey, 13 and a modified Delphi technique.…”

Demographic profile; changing trends in patients with HIV/AIDS in response to anti-retroviral therapy - a study from tertiary care centre

“…20 ART initiation guidelines used in developing countries have been based on both clinical and laboratory parameters. 21 Earlier ART initiation is supported by recognition of lower HIV transmission from HIV-infected partners of discordant sexual relationships, with CD4 cell counts above current treatment thresholds, who are receiving effective ART and universal early initiation of ART has the potential to prevent HIV transmission at a population level. [22][23][24][25] Greater declines in estimated annual deaths are noted in states where significant scale up of ART services has been achieved.…”