title: HIV Treatment in Resource-Limited Environments: Treatment Coverage and Insights.
abstract: BACKGROUND
  The effects of antiretroviral treatment on the HIV epidemic are complex. HIV-infected individuals survive longer with treatment, but are less likely to transmit the disease. The standard coverage measure improves with the deaths of untreated individuals and does not consider the fact that some individuals may acquire the disease and die before receiving treatment, making it susceptible to overestimating the long-run performance of antiretroviral treatment programs.
  
  
  OBJECTIVE
  The objective was to propose an alternative coverage definition to better measure the long-run performance of HIV treatment programs.
  
  
  METHODS
  We introduced cumulative incidence-based coverage as an alternative to measure an HIV treatment program's success. To numerically compare the definitions, we extended a simulation model of HIV disease and treatment to represent a dynamic population that includes uninfected and HIV-infected individuals. Also, we estimated the additional resources required to implement various treatment policies in a resource-limited setting.
  
  
  RESULTS
  In a synthetic population of 600,000 people of which 44,000 (7.6%) are infected, and eligible for treatment with a CD4 count of less than 500 cells/mm(3), assuming a World Health Organization (WHO)-defined coverage rate of 50% of eligible people, and treating these individuals with a single treatment regimen, the gap between the current WHO coverage definition and our proposed one is as much as 16% over a 10-year planning horizon.
  
  
  CONCLUSIONS
  Cumulative incidence-based definition of coverage yields a more accurate representation of the long-run treatment success and along with the WHO and other definitions of coverage provides a better understanding of the HIV treatment progress.
authors.affiliation: Department of Industrial Engineering, Clemson University, Clemson, SC, USA. Electronic address: Khademi@clemson.edu.
authors.forename: Amin
authors.initials: A
authors.lastname: Khademi
authors.affiliation: Department of Industrial Engineering, University of Chile, Santiago, Chile.
authors.forename: Denis
authors.initials: D
authors.lastname: Saure
authors.affiliation: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Section of Value and Comparative Effectiveness, NYU School of Medicine, New York, NY, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nucifora
authors.affiliation: Section of Value and Comparative Effectiveness, NYU School of Medicine, New York, NY, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Braithwaite
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003198:Computer Simulation; D018450:Disease Progression; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008962:Models, Theoretical; D011204:Poverty Areas; D015397:Program Evaluation / Q000379:methods*
chemical_list: D019380:Anti-HIV Agents
keywords: HIV treatment; antiretroviral therapy; coverage; resource-limited; simulation