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

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

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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
10.2174/157016211798038533
Modelling the Impact of Antiretroviral Therapy on the Epidemic of HIV
B. Williams (2011)
10.2174/157016211798038588
Articulating A Rights-Based Approach to HIV Treatment and Prevention Interventions
D. Barr (2011)
10.2174/157016211798038515
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)
10.1016/S1473-3099(02)00346-8
Could widespread use of combination antiretroviral therapy eradicate HIV epidemics?
J. X. Velasco-Hernández (2002)
10.1371/journal.pone.0011068
Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco
Moupali Das (2010)
10.1001/jama.2010.993
Use of generic antiretroviral agents and cost savings in PEPFAR treatment programs.
C. Holmes (2010)
10.1016/j.epidem.2009.03.001
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)
10.1016/S0140-6736(10)60894-X
Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial
I. Sanne (2010)
10.1038/350356A0
Potential of community-wide chemotherapy or immunotherapy to control the spread of HIV-1
R. Anderson (1991)
10.1371/journal.pmed.1001055
Treatment Outcomes and Cost-Effectiveness of Shifting Management of Stable ART Patients to Nurses in South Africa: An Observational Cohort
L. Long (2011)
10.1097/QAD.0b013e32833f6ea2
Antiretroviral treatment is a behavioural intervention: but why?
S. Gregson (2010)
10.1016/S0140-6736(10)60705-2
Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis
D. Donnell (2010)
10.1016/S0140-6736(08)61698-0
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)
10.1097/00002030-200309050-00013
Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda
R. Gray (2003)
10.1093/infdis/jir651
Analysis of genetic linkage of HIV from couples enrolled in the HIV Prevention Trials Network 052 trial.
S. Eshleman (2011)
10.1097/QAD.0b013e32834b6464
Antiretroviral therapy refusal among newly diagnosed HIV-infected adults
I. Katz (2011)
10.1056/NEJMoa1105243
Prevention of HIV-1 infection with early antiretroviral therapy.
M. Cohen (2011)
10.1016/S0140-6736(06)69162-9
The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic
J. Montaner (2006)
10.1016/S0140-6736(08)61697-9
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
R. Granich (2009)
10.1016/S0140-6736(10)60666-6
Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes
M. May (2010)
10.1371/journal.pone.0021919
The Impact of the New WHO Antiretroviral Treatment Guidelines on HIV Epidemic Dynamics and Cost in South Africa
Jan A. C. Hontelez (2011)
10.1086/422601
Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan.
C. Fang (2004)
10.2105/AJPH.92.3.388
Impact of highly active antiretroviral treatment on HIV seroincidence among men who have sex with men: San Francisco.
M. Katz (2002)
10.1371/journal.pmed.1000163
Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda
Fabienne Shumbusho (2009)
10.2471/BLT.08.058925
Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases.
B. Waning (2009)
10.1016/S0140-6736(11)60842-8
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)
10.1016/S0140-6736(11)60702-2
Towards an improved investment approach for an effective response to HIV/AIDS
B. Schwartländer (2011)
10.2165/11586120-000000000-00000
Unit Costs for Delivery of Antiretroviral Treatment and Prevention of Mother-to-Child Transmission of HIV
O. Galárraga (2012)
10.1136/jfprhc-2012-100379
Prevention of HIV-1 infection with early antiretroviral therapy
M. Rayment (2012)
10.1186/1471-2458-9-S1-S6
Factors influencing global antiretroviral procurement prices
V. Wirtz (2009)
10.1097/QAD.0b013e3282fd167c
A resurgent HIV-1 epidemic among men who have sex with men in the era of potent antiretroviral therapy
D. Bezemer (2008)
10.1038/73104
Both a ‘magic bullet’ and good aim are required to link public health interests and health care needs in HIV infection
G. Garnett (2000)
10.1136/sti.2006.019950
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)
10.1038/nm0702-651
Antiretroviral therapy to treat and prevent HIV/AIDS in resource-poor settings
G. Garnett (2002)
10.1097/QAD.0b013e32833433fe
Examining the promise of HIV elimination by ‘test and treat’ in hyperendemic settings
P. Dodd (2010)
10.1093/JAC/37.SUPPL_B.135
Antiviral therapy and the transmission dynamics of HIV-1.
G. Garnett (1996)
10.1056/NEJM200003303421303
Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group.
T. Quinn (2000)
10.1016/S0140-6736(10)60936-1
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
10.1371/journal.pmed.1001610
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)
10.1016/J.COVIRO.2012.07.004
Human viral diseases: what is next for antiviral drug discovery?
E. Clercq (2012)
10.1353/hpu.2014.0113
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)
10.1001/jamanetworkopen.2020.14650
Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV
Sylvie Naar (2020)
10.1097/QAI.0000000000000271
Phylogenetic Studies of Transmission Dynamics in Generalized HIV Epidemics: An Essential Tool Where the Burden is Greatest?
Ann M. Dennis (2014)
10.1080/17290376.2012.744168
New HIV prevention technologies and their relevance to MARPS in African epidemics
K. Rebe (2012)
10.2105/AJPH.2013.301273
Clinical uncertainties, health service challenges, and ethical complexities of HIV "test-and-treat": a systematic review.
Sonali P. Kulkarni (2013)
10.1080/09540121.2013.764394
Minimal interference: A basis for selecting ART for prevention with positives
B. Lebouché (2013)
10.1371/journal.pmed.1001643
Antiretroviral Therapy for Refugees and Internally Displaced Persons: A Call for Equity
Joshua B. Mendelsohn (2014)
10.1093/cid/ciu339
Modeling scenarios for the end of AIDS.
V. Lima (2014)
10.1007/s11904-014-0234-8
Role of Oral Pre-exposure Prophylaxis (PrEP) in Current and Future HIV Prevention Strategies
D. Burns (2014)
10.1016/j.coviro.2012.07.004
Human viral diseases: what is next for antiviral drug discovery?
E. De Clercq (2012)
10.1007/s11904-014-0226-8
Palliative HIV Care: Opportunities for Biomedical and Behavioral Change
E. W. Farber (2014)
10.1097/QAD.0000000000000273
Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States
C. Mattson (2014)
10.1371/journal.pone.0087872
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)
10.1177/2325957413488196
French HIV Experts on Early Antiretroviral Treatment for Prevention
B. Lebouché (2014)
10.1007/s10461-012-0186-1
Behavioral Factors in Assessing Impact of HIV Treatment as Prevention
D. Holtgrave (2012)
10.1371/journal.pone.0076483
Steps towards Preventive HIV Treatment in Fujian, China: Problems Identified via an Assessment of Initial Antiretroviral Therapy Provision
P. Xia (2013)
10.1017/S1463423613000108
Expert perspectives on the contribution of HIV general practice nursing to the 'extraordinary story' of HIV medicine in Australia.
Max Hopwood (2014)
10.1155/2013/190190
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)
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