Integrating HIV Prevention and Treatment: From Slogans to Impact

Abstract

Background Through major efforts to reduce costs and expand access to antiretroviral therapy worldwide, widespread delivery of effective treatment to people living with HIV/AIDS is now conceivable even in severely resource-constrained settings. However, the potential epidemiologic impact of treatment in the context of a broader strategy for HIV/AIDS control has not yet been examined. In this paper, we quantify the opportunities and potential risks of large-scale treatment roll-out. Methods and Findings We used an epidemiologic model of HIV/AIDS, calibrated to sub-Saharan Africa, to investigate a range of possible positive and negative health outcomes under alternative scenarios that reflect varying implementation of prevention and treatment. In baseline projections, reflecting “business as usual,” the numbers of new infections and AIDS deaths are expected to continue rising. In two scenarios representing treatment-centered strategies, with different assumptions about the impact of treatment on transmissibility and behavior, the change in the total number of new infections through 2020 ranges from a 10% increase to a 6% reduction, while the number of AIDS deaths through 2020 declines by 9% to 13%. A prevention-centered strategy provides greater reductions in incidence (36%) and mortality reductions similar to those of the treatment-centered scenarios by 2020, but more modest mortality benefits over the next 5 to 10 years. If treatment enhances prevention in a combined response, the expected benefits are substantial—29 million averted infections (55%) and 10 million averted deaths (27%) through the year 2020. However, if a narrow focus on treatment scale-up leads to reduced effectiveness of prevention efforts, the benefits of a combined response are considerably smaller—9 million averted infections (17%) and 6 million averted deaths (16%). Combining treatment with effective prevention efforts could reduce the resource needs for treatment dramatically in the long term. In the various scenarios the numbers of people being treated in 2020 ranges from 9.2 million in a treatment-only scenario with mixed effects, to 4.2 million in a combined response scenario with positive treatment–prevention synergies. Conclusions These analyses demonstrate the importance of integrating expanded care activities with prevention activities if there are to be long-term reductions in the number of new HIV infections and significant declines in AIDS mortality. Treatment can enable more effective prevention, and prevention makes treatment affordable. Sustained progress in the global fight against HIV/AIDS will be attained only through a comprehensive response.

Vulnerability and non-adherence to antiretroviral therapy among HIV patients, Minas Gerais State, Brazil

“…In the present study, the GoM model estimated the degree to which each patient in the data set belonged to each of these pure profiles. Each patient was, then, represented by a set of grade of membership or scores, g ik where "i" is the individual and "k" the pure type, which vary between zero (0) and one (1), and add up to one for each individual, specifying the state of that person. For example an individual for which a certain set of behavior characteristics is defined might have a grade of membership of 0.6 for one "extreme profile", 0.2 for the second, and 0.2 for the third, in a fuzzy set terminology.…”

“…Systematic screening of blood donations, voluntary testing of pregnant women, early diagnosis through counseling and testing of at risk populations (e.g., those with risky sexual behavior and drug use) and dissemination of adequate information about methods for preventing HIV transmission are among the strategies aimed at reducing the chances of acquiring or spreading HIV 1 .…”

Measuring the Cost Effectiveness of HIV Prevention Interventions in the US: Pitfalls and Problems

“…Earlier studies have assessed specific HIV interventions, but only a few studies have attempted to estimate the impact of a combination of interventions [16,17]. Yet, many public health officials now believe that a flexible approach that entails a combination of HIV prevention interventions represents the best way to curb the transmission of HIV, and studies that evaluate the impact of a combination of HIV prevention interventions require the development of models that are capable of estimating the combined effect of multiple interventions.…”

Conocimientos, actitudes y prácticas acerca del VIH/SIDA en jóvenes de nivel medio de Educación, del área metropolitana, Paraguay

“…Del total de la muestra correspondió a colegios privados 2 el 29% (98/336) y 71% (238 7.336) a colegios públicos 4 . La frecuencia de participantes por cada colegio se observa en la figura 1.…”

“…Los esfuerzos para ampliar rápida-mente y sostener el acceso al tratamiento antiretroviral se verán debilitados si no se rompe el ciclo de las nuevas infecciones por VIH. Cada vez se reconoce más que para ir por delante de la epidemia deben ampliarse e intensificarse los esfuerzos de prevención [2][3][4] .…”