HIV treatment as prevention: optimising the impact of expanded HIV treatment programmes.
Until now, decisions about how to allocate ART have largely been based on maximising the therapeutic benefit of ART for patients. Since the results of the HPTN 052 study showed efficacy of antiretroviral therapy (ART) in preventing HIV transmission, there has been increased interest in the benefits of ART not only as treatment, but also in prevention. Resources for expanding ART in the short term may be limited, so the question is how to generate the most prevention benefit from realistic potential increases in the availability of ART. Although not a formal systematic review, here we review different ways in which access to ART could be expanded by prioritising access to particular groups based on clinical or behavioural factors. For each group we consider (i) the clinical and epidemiological benefits, (ii) the potential feasibility, acceptability, and equity, and (iii) the affordability and cost-effectiveness of prioritising ART access for that group. In re-evaluating the allocation of ART in light of the new data about ART preventing transmission, the goal should be to create policies that maximise epidemiological and clinical benefit while still being feasible, affordable, acceptable, and equitable.
South African Department of Science and Technology/National Research Foundation Centre for Excellence in Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa. Wim.Delva@ugent.be
Wim
W
Delva
Jeffrey W
JW
Eaton
Fei
F
Meng
Christophe
C
Fraser
Richard G
RG
White
Peter
P
Vickerman
Marie-Claude
MC
Boily
Timothy B
TB
Hallett
D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006285:Health Planning; D006801:Humans
D019380:Anti-HIV Agents