Examining the promise of HIV elimination by 'test and treat' in hyperendemic settings.
Examining the promise of HIV elimination by 'test and treat' in hyperendemic settings.
复制标题
DOI：
10.1097/qad.0b013e32833433fe
复制
发表时间：
2010-03-13
期刊：
影响因子：
--
通讯作者：
Hallett TB
中科院分区：
文献类型：
--
作者：
Dodd PJ;Garnett GP;Hallett TB
有人建议，艾滋病毒预防的新策略“普遍检测和治疗”，即每个人每年接受一次艾滋病毒检测，如果感染，立即接受抗逆转录病毒治疗（ART）治疗，从长远来看，可以“消除”这种流行病并降低 ART 成本。我们使用确定性数学模型研究了在有关流行病的各种假设下测试和治疗干预措施的影响。我们的模型表明，这种干预措施可以大幅减少艾滋病毒传播，但这种影响很大程度上取决于流行病学背景——在某些情况下，不太积极的干预措施可以达到相同的结果，而在其他情况下，拟议的干预措施减少艾滋病毒的程度要小得多。由此可见，每年检测并立即治疗并不一定是最具成本效益的策略。我们还表明，未达到全面实施或覆盖范围的“测试和治疗”干预措施可能会反而增加长期抗逆转录病毒疗法的成本。通过扩大抗逆转录病毒治疗来预防新感染的干预措施可能会带来巨大的希望。然而，随着计划的推进，应仔细考虑该流行病的性质和可能出现的不良结果。
It has been suggested that a new strategy for HIV prevention, “Universal Test and Treat”, whereby everyone is tested for HIV once a year and treated immediately with antiretroviral therapy (ART) if they are infected, could ‘eliminate’ the epidemic and reduce ART costs in the long-term. We investigated the impact of Test and Treat interventions under a variety of assumptions about the epidemic using a deterministic mathematical model. Our model shows that such an intervention can substantially reduce HIV transmission, but that impact depends crucially on the epidemiological context – in some situations less aggressive interventions achieve the same results, whilst in others the proposed intervention reduces HIV by much less. It follows that testing every year and treating immediately is not necessarily the most cost-efficient strategy. We also show that a Test and Treat intervention that does not reach full implementation or coverage could, perversely, increase long-term ART costs. Interventions that prevent new infections through ART scale-up may hold substantial promise. However, as plans move forward, careful consideration should be given to the nature of the epidemic and the potential for perverse outcomes.