Increasing survival time decreases the cost-effectiveness of using "test & treat'' to eliminate HIV epidemics.
Treating HIV-infected individuals reduces their viral load, consequently increasing their survival time and decreasing their infectivity. It has been proposed that universal testing and treatment (i.e., universal "test & treat'') could lead to HIV elimination and would be extremely cost-effective. It is now being debated whether to use a universal "test & treat'' approach in the "real-world'' as a prevention strategy to control HIV epidemics. However current modeling predictions of the impact, and cost-effectiveness, of universal `"est & treat'' strategies are based on an unrealistically short survival time for treated individuals. Here we use mathematical modeling and a longer, more realistic, survival time. We model the potential impact of a universal "test & treat'' strategy in South Africa. Our results show that increasing the length of the survival time on treatment, although beneficial to individuals, reduces the probability of eliminating HIV and decreases the cost-effectiveness of using universal "test & treat'' strategies. Therefore our results show that individual-level benefits and public health benefits will conflict when using "test &treat'' strategies to reduce HIV transmission.
Center for Biomedical Modeling, Semel Institute of Neuroscience & Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1450, Los Angeles, CA 90024, United States. bwagner@intven.com.
Bradley G
BG
Wagner
Brian J
BJ
Coburn
Sally
S
Blower
D000293:Adolescent; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D003140:Communicable Disease Control / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011336:Probability; D012306:Risk; D012725:Sexual Behavior; D013019:South Africa; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult