HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes


Delva, W; Eaton, JW; Meng, F; Fraser, C; White, RG; Vickerman, P; Boily, MC; Hallett, TB; (2012) HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes. PLoS medicine, 9 (7). e1001258. ISSN 1549-1277 DOI: https://doi.org/10.1371/journal.pmed.1001258

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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.<br/>

Item Type: Article
Keywords: 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, female sex workersto-child transmissionactive antiretroviraltherapysexually-transmitted diseasesresource-limited settingsinjecting drug-userssub-saharan africasouth-africarisk behaviorviral load
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 22802738
Web of Science ID: 307106400014
URI: http://researchonline.lshtm.ac.uk/id/eprint/251258

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