Universal testing and treatment as an HIV prevention strategy: research questions and methods.
Universal testing and treatment as an HIV prevention strategy: research questions and methods.
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DOI：
10.2174/157016211798038515
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发表时间：
2011-09
影响因子：
1
通讯作者：
Fidler S
中科院分区：
文献类型：
--
作者：
Hayes R;Sabapathy K;Fidler S
除非能够大幅降低艾滋病毒发病率，否则在资源匮乏的地区实现抗逆转录病毒治疗（ART）的高覆盖率将变得越来越困难。对所有诊断为艾滋病毒呈阳性的人进行全民自愿咨询和检测，然后立即开始抗逆转录病毒治疗（全民检测和治疗，UTT）有可能大幅降低艾滋病毒发病率，但短期内实施起来非常具有挑战性且成本高昂。该领域的早期建模工作因对干预措施的采用和覆盖范围做出过度乐观的假设而受到批评。在未来的工作中，模型参数必须切合实际并尽可能基于经验数据，这一点很重要。在考虑大规模实施 UTT 方法之前，需要严格的研究证据。本文回顾了需要探索的主要领域。我们依次考虑与提供普遍检测服务、艾滋病毒阳性者立即治疗服务和 UTT 对人群影响相关的研究问题，以及可用于解决这些问题的研究方法。理想情况下，应进行初步可行性研究，以调查 UTT 服务的可接受性、可行性和采用情况。如果这些研究产生了有希望的结果，那么就有充分的理由进行整群随机试验来衡量 UTT 干预对 HIV 发病率的影响，并且我们考虑了此类试验的主要设计特征。
Achieving high coverage of antiretroviral treatment (ART) in resource-poor settings will become increasingly difficult unless HIV incidence can be reduced substantially. Universal voluntary counselling and testing followed by immediate initiation of ART for all those diagnosed HIV-positive (universal testing and treatment, UTT) has the potential to reduce HIV incidence dramatically but would be very challenging and costly to deliver in the short term. Early modelling work in this field has been criticised for making unduly optimistic assumptions about the uptake and coverage of interventions. In future work, it is important that model parameters are realistic and based where possible on empirical data. Rigorous research evidence is needed before the UTT approach could be considered for wide-scale implementation. This paper reviews the main areas that need to be explored. We consider in turn research questions related to the provision of services for universal testing, services for immediate treatment of HIV-positives and the population-level impact of UTT, and the research methods that could be used to address these questions. Ideally, initial feasibility studies should be carried out to investigate the acceptability, feasibility and uptake of UTT services. If these studies produce promising results, there would be a strong case for a cluster-randomised trial to measure the impact of a UTT intervention on HIV incidence, and we consider the main design features of such a trial.
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影响因子：
4.5
作者：
Callaghan M;Ford N;Schneider H
通讯作者：
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影响因子：
15.8
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影响因子：
3.3
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通讯作者：
Boelaert, M