Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV “Test-and-Treat”: A Systematic Review

Kulkarni, Sonali P.; Shah, Kavita; Sarma, Karthik V.

doi:10.2105/ajph.2013.301273

Cited by 34 publications

(31 citation statements)

References 110 publications

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“…This may best be accomplished by a multi-faceted approach that augments current HIV testing approaches (e.g., clinic-based counselor model) with selfimplemented testing and innovated dissemination strategies [5,54,55]. The present study points out a wide range of variables that may impact SIT implementation fidelity, which require further testing in laboratory and field settings.…”

Section: Discussionmentioning

confidence: 89%

“…CHPA includes enhanced HIV testing services targeting high risk persons, linkage-to-care, treatment with AIDS antiretrovirals, treatment adherence/retention programs, partners' prevention programs, and behavioral interventions focused on high risk persons. Underlying CHPA's successful implementation are a variety of organizational, social, and behavioral processes [5,6] (e.g., test-seeking, treatment adherence).…”

Section: Overviewmentioning

confidence: 99%

“…HIV testing for high risk persons is a key stepping stone in the CHPA system [5]. HIV testing leads to identifying HIV-positive persons and linking them to biomedical and behavioral prevention programs.…”

Section: Overviewmentioning

confidence: 99%

“…In general, increasing HIV testing rates among atrisk African American youth and young adults may best be accomplished by a multi-faceted approach that augments current HIV testing strategies (e.g., clinicbased, counselor model) with self-implemented testing methods [5]. Increasing HIV testing rates in these population segments is a significant goal and critical to the CDC's CHPA.…”

Section: Overviewmentioning

confidence: 99%

“…This may best be accomplished by a multifaceted approach that augments current HIV testing strategies (e.g., clinic-based, counselor model) with self-implemented testing methods and innovated dissemination through nontraditional testing sites [5].…”

Section: Overviewmentioning

confidence: 99%

See 4 more Smart Citations

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth

Catania

Dolcini

Harper

et al. 2015

Behav. Med. Pract. Policy Res.

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Section: Discussionmentioning

confidence: 89%

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

See 3 more Smart Citations

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth

Catania

Dolcini

Harper

et al. 2015

Behav. Med. Pract. Policy Res.

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What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?

et al. 2020

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Introduction Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population‐based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub‐Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90‐90‐90 campaign. Discussion These three‐year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community‐based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient‐centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population‐level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub‐populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured. Conclusions These trials provide strong evidence that UTT inclusive of universal testing increases population‐level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub‐country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.

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HIV Therapy—The State of ART

Looney

Johns

2015

The Future of HIV-1 Therapeutics

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HIV Attachment. In this cross section, HIV is shown at the top and a target cell is shown at the bottom in blues. HIV envelope protein (A) has bound to the receptor CD4 (B) and then to coreceptor CCR5 (C), causing a change in conformation that inserts fusion peptides into the cellular membrane Antiretroviral therapy changed the face of HIV/AIDS from that of soon and certain death to that of a chronic disease in the years following introduction of highly active antiretroviral therapy in 1995-1996 (initially termed HAART, but now most often abbreviated to ART since not all combinations of regimens are equally active). Since then, many new agents have been developed and introduced in response to problems of resistance, toxicity, and tolerability, and great advances have been achieved in accessibility of HIV drugs in resource-poor global regions. Potential challenges that providers of HIV therapy will face in the coming decade include continuing problems with resistance, especially where access to drugs is inconsistent, determining how best to combine new and existing agents, defining the role of preventive treatment (pre-exposure prophylaxis or PrEP), and evaluating the potential of strategies for cure in some populations.

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Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV “Test-and-Treat”: A Systematic Review

Cited by 34 publications

References 110 publications

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth

What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?

HIV Therapy—The State of ART

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