Online citations, reference lists, and bibliographies.
← Back to Search

Treatment As Prevention: Translating Efficacy Trial Results To Population Effectiveness.

G. Garnett, S. Becker, S. Bertozzi
Published 2012 · Medicine

Cite This
Download PDF
Analyze on Scholarcy
PURPOSE OF REVIEW The understanding that antiretroviral treatment prevents HIV transmission through suppression of viral load provides significant new opportunities in HIV prevention. However, knowledge of efficacy is only a first step to having an impact on the spread of HIV at a population level, the ultimate goal of all primary prevention modalities. This review explores what we know about treatment as prevention and how it could be used as a tool, as part of a combination approach, in the global response to HIV. RECENT FINDINGS Efficacy data show that treatment as prevention works at high levels in trial conditions in stable serodiscordant couples; a finding that can reasonably be generalized to other populations at risk of transmitting the virus. Modelling shows that treatment as prevention should have an impact, but the extent of this depends primarily upon whether optimistic or pessimistic assumptions are made about the programmatic use of antiretrovirals (ARVs). SUMMARY We describe research questions that need to be addressed in developing optimal programmatic public health treatment strategies including how best to target and implement the use of treatment as prevention, how to balance the needs of treatment for the individual patients' clinical benefit against population level benefits, and how to create programmes that are able to link people to and retain them in care.
This paper references
Modelling the Impact of Antiretroviral Therapy on the Epidemic of HIV
B. Williams (2011)
Articulating A Rights-Based Approach to HIV Treatment and Prevention Interventions
D. Barr (2011)
Universal Testing and Treatment as an HIV Prevention Strategy: Research Questions and Methods
R. Hayes (2011)
ART in Prevention of HIV and TB: Update on Current Research Efforts
R. Granich (2011)
Could widespread use of combination antiretroviral therapy eradicate HIV epidemics?
J. X. Velasco-Hernández (2002)
Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco
Moupali Das (2010)
Use of generic antiretroviral agents and cost savings in PEPFAR treatment programs.
C. Holmes (2010)
Assessing evidence for behaviour change affecting the course of HIV epidemics: a new mathematical modelling approach and application to data from Zimbabwe.
T. Hallett (2009)
Use of antiretroviral drugs to prevent sexual transmission of HIV.
M. Cohen (2002)
Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial
I. Sanne (2010)
Potential of community-wide chemotherapy or immunotherapy to control the spread of HIV-1
R. Anderson (1991)
Treatment Outcomes and Cost-Effectiveness of Shifting Management of Stable ART Patients to Nurses in South Africa: An Observational Cohort
L. Long (2011)
Antiretroviral treatment is a behavioural intervention: but why?
S. Gregson (2010)
Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis
D. Donnell (2010)
Treating our way out of the HIV pandemic: could we, would we, should we?
G. Garnett (2009)
Vital signs: HIV prevention through care and treatment--United States.
Stacy M Cohen (2011)
Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda
R. Gray (2003)
Analysis of genetic linkage of HIV from couples enrolled in the HIV Prevention Trials Network 052 trial.
S. Eshleman (2011)
Antiretroviral therapy refusal among newly diagnosed HIV-infected adults
I. Katz (2011)
Prevention of HIV-1 infection with early antiretroviral therapy.
M. Cohen (2011)
The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic
J. Montaner (2006)
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
R. Granich (2009)
Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes
M. May (2010)
The Impact of the New WHO Antiretroviral Treatment Guidelines on HIV Epidemic Dynamics and Cost in South Africa
Jan A. C. Hontelez (2011)
Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan.
C. Fang (2004)
Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco.
M. Katz (2002)
Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda
Fabienne Shumbusho (2009)
Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases.
B. Waning (2009)
The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: a modelling study
K. Powers (2011)
Unit costs for delivery of antiretroviral treatment and prevention of mothertochild transmission of HIV : a systematic review for lowand middle - income countries
O Galarraga (2010)
Towards an improved investment approach for an effective response to HIV/AIDS
B. Schwartländer (2011)
Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV
O. Galárraga (2012)
Prevention of HIV-1 infection with early antiretroviral therapy
M. Rayment (2012)
Factors influencing global antiretroviral procurement prices
V. Wirtz (2009)
A resurgent HIV-1 epidemic among men who have sex with men in the era of potent antiretroviral therapy
D. Bezemer (2008)
Both a ‘magic bullet’ and good aim are required to link public health interests and health care needs in HIV infection
G. Garnett (2000)
Increases in sexually transmitted infections and sexual risk behaviour without a concurrent increase in HIV incidence among men who have sex with men in San Francisco: a suggestion of HIV serosorting?
H. Truong (2006)
Antiretroviral therapy to treat and prevent HIV/AIDS in resource-poor settings
G. Garnett (2002)
Examining the promise of HIV elimination by ‘test and treat’ in hyperendemic settings
P. Dodd (2010)
Antiviral therapy and the transmission dynamics of HIV-1.
G. Garnett (1996)
Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group.
T. Quinn (2000)
Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study
J. Montaner (2010)

This paper is referenced by
The Role of Viral Introductions in Sustaining Community-Based HIV Epidemics in Rural Uganda: Evidence from Spatial Clustering, Phylogenetics, and Egocentric Transmission Models
M. Grabowski (2014)
Human viral diseases: what is next for antiviral drug discovery?
E. Clercq (2012)
HIV Testing and Engagement in Care among Highly Vulnerable Female Sex Workers: Implications for Treatment as Prevention Models
H. Surratt (2014)
La mégère apprivoisée : élaborer des stratégies pour la gestion de la résistance aux médicaments dans la grippe et l'infection par le virus de l'immunodéficience humaine
Barbara Rath (2012)
Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV
Sylvie Naar (2020)
Phylogenetic Studies of Transmission Dynamics in Generalized HIV Epidemics: An Essential Tool Where the Burden is Greatest?
Ann M. Dennis (2014)
New HIV prevention technologies and their relevance to MARPS in African epidemics
K. Rebe (2012)
Clinical uncertainties, health service challenges, and ethical complexities of HIV "test-and-treat": a systematic review.
Sonali P. Kulkarni (2013)
Minimal interference: A basis for selecting ART for prevention with positives
B. Lebouché (2013)
Antiretroviral Therapy for Refugees and Internally Displaced Persons: A Call for Equity
Joshua B. Mendelsohn (2014)
Modeling scenarios for the end of AIDS.
V. Lima (2014)
Role of Oral Pre-exposure Prophylaxis (PrEP) in Current and Future HIV Prevention Strategies
D. Burns (2014)
Human viral diseases: what is next for antiviral drug discovery?
E. De Clercq (2012)
Palliative HIV Care: Opportunities for Biomedical and Behavioral Change
E. W. Farber (2014)
Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States
C. Mattson (2014)
Expansion of HAART Coverage Is Associated with Sustained Decreases in HIV/AIDS Morbidity, Mortality and HIV Transmission: The “HIV Treatment as Prevention” Experience in a Canadian Setting
J. Montaner (2014)
French HIV Experts on Early Antiretroviral Treatment for Prevention
B. Lebouché (2014)
Behavioral Factors in Assessing Impact of HIV Treatment as Prevention
D. Holtgrave (2012)
Steps towards Preventive HIV Treatment in Fujian, China: Problems Identified via an Assessment of Initial Antiretroviral Therapy Provision
P. Xia (2013)
Expert perspectives on the contribution of HIV general practice nursing to the 'extraordinary story' of HIV medicine in Australia.
Max Hopwood (2014)
North-South Corridor Demonstration Project: Ethical and Logistical Challenges in the Design of a Demonstration Study of Early Antiretroviral Treatment for Long Distance Truck Drivers along a Transport Corridor through South Africa, Zimbabwe, and Zambia
G. Gómez (2013)
Semantic Scholar Logo Some data provided by SemanticScholar