HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2012-07-10
Date Acceptance
2012-07-10
Citation
PLOS Medicine, 2012, 9 (7)
ISSN
1549-1277
Publisher
Public Library of Science
Journal / Book Title
PLOS Medicine
Volume
9
Issue
7
Copyright Statement
© 2012 Delva et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Sponsor
Medical Research Council (MRC)
Medical Research Council (MRC)
Grant Number
G0600719B
G0800596
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
MEDICINE, GENERAL & INTERNAL
FEMALE SEX WORKERS
TO-CHILD TRANSMISSION
ACTIVE ANTIRETROVIRAL THERAPY
SEXUALLY-TRANSMITTED DISEASES
RESOURCE-LIMITED SETTINGS
INJECTING DRUG-USERS
SUB-SAHARAN AFRICA
SOUTH-AFRICA
RISK BEHAVIOR
VIRAL LOAD
Anti-HIV Agents
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
HIV Infections
Health Planning
Humans
11 Medical And Health Sciences
Publication Status
Published
Article Number
e1001258