Universal access to HIV treatment versus universal 'test and treat': transmission, drug resistance & treatment costs
In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ~1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal 'test and treat' (T&T) strategy to try to el...
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| Veröffentlicht in: | PloS one 2012-09, Vol.7 (9), p.e41212-e41212 |
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| description | In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ~1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal 'test and treat' (T&T) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a T&T strategy all HIV-infected individuals would receive treatment whether in need or not. This would require treating 5 million individuals almost immediately and providing treatment for several decades. We use a validated mathematical model to predict impact and costs of: (i) a universal T&T strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal T&T strategy in SA would eliminate HIV within a decade, and (after 40 years) cost ~$10 billion less than achieving universal access. In contrast, we predict a universal T&T strategy in SA could eliminate HIV, but take 40 years and cost ~$12 billion more than achieving universal access. We determine the difference in predictions is because the WHO has under-estimated survival time on treatment and ignored the risk of resistance. We predict, after 20 years, ~2 million individuals would need second-line regimens if a universal T&T strategy is implemented versus ~1.5 million if universal access is achieved. Costs need to be realistically estimated and multiple evaluation criteria used to compare 'treatment as prevention' with other prevention strategies. Before implementing a universal T&T strategy, which may not be sustainable, we recommend striving to achieve universal access to treatment as quickly as possible. We predict achieving universal access to treatment would be a very effective 'treatment as prevention' approach and bring the HIV epidemic in SA close to elimination, preventing ~4 million infections after 20 years and ~11 million after 40 years. |
| doi_str_mv | 10.1371/journal.pone.0041212 |
| format | Article |
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William</contributor><creatorcontrib>Wagner, Bradley G ; Blower, Sally ; Cameron, D. William</creatorcontrib><description><![CDATA[In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ~1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal 'test and treat' (T&T) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a T&T strategy all HIV-infected individuals would receive treatment whether in need or not. This would require treating 5 million individuals almost immediately and providing treatment for several decades. We use a validated mathematical model to predict impact and costs of: (i) a universal T&T strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal T&T strategy in SA would eliminate HIV within a decade, and (after 40 years) cost ~$10 billion less than achieving universal access. In contrast, we predict a universal T&T strategy in SA could eliminate HIV, but take 40 years and cost ~$12 billion more than achieving universal access. We determine the difference in predictions is because the WHO has under-estimated survival time on treatment and ignored the risk of resistance. We predict, after 20 years, ~2 million individuals would need second-line regimens if a universal T&T strategy is implemented versus ~1.5 million if universal access is achieved. Costs need to be realistically estimated and multiple evaluation criteria used to compare 'treatment as prevention' with other prevention strategies. Before implementing a universal T&T strategy, which may not be sustainable, we recommend striving to achieve universal access to treatment as quickly as possible. We predict achieving universal access to treatment would be a very effective 'treatment as prevention' approach and bring the HIV epidemic in SA close to elimination, preventing ~4 million infections after 20 years and ~11 million after 40 years.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0041212</identifier><identifier>PMID: 22957012</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; AIDS ; AIDS treatment ; Analysis ; Antiretroviral drugs ; CD4-Positive T-Lymphocytes - cytology ; Communicable Disease Control ; Computer Science ; Costs ; Drug resistance ; Drug Resistance, Viral ; Economic aspects ; Epidemics ; Health Care Costs ; Health Services Accessibility ; Health Services Needs and Demand - economics ; HIV ; HIV Infections - diagnosis ; HIV Infections - economics ; HIV Infections - epidemiology ; HIV Infections - therapy ; Human immunodeficiency virus ; Humans ; Infectivity ; Mathematical models ; Medicine ; Models, Theoretical ; Predictions ; Prevalence ; Prevention ; South Africa ; Strategy ; World Health Organization</subject><ispartof>PloS one, 2012-09, Vol.7 (9), p.e41212-e41212</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>Wagner, Blower. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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William</contributor><creatorcontrib>Wagner, Bradley G</creatorcontrib><creatorcontrib>Blower, Sally</creatorcontrib><title>Universal access to HIV treatment versus universal 'test and treat': transmission, drug resistance & treatment costs</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ~1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal 'test and treat' (T&T) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a T&T strategy all HIV-infected individuals would receive treatment whether in need or not. This would require treating 5 million individuals almost immediately and providing treatment for several decades. We use a validated mathematical model to predict impact and costs of: (i) a universal T&T strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal T&T strategy in SA would eliminate HIV within a decade, and (after 40 years) cost ~$10 billion less than achieving universal access. In contrast, we predict a universal T&T strategy in SA could eliminate HIV, but take 40 years and cost ~$12 billion more than achieving universal access. We determine the difference in predictions is because the WHO has under-estimated survival time on treatment and ignored the risk of resistance. We predict, after 20 years, ~2 million individuals would need second-line regimens if a universal T&T strategy is implemented versus ~1.5 million if universal access is achieved. Costs need to be realistically estimated and multiple evaluation criteria used to compare 'treatment as prevention' with other prevention strategies. Before implementing a universal T&T strategy, which may not be sustainable, we recommend striving to achieve universal access to treatment as quickly as possible. We predict achieving universal access to treatment would be a very effective 'treatment as prevention' approach and bring the HIV epidemic in SA close to elimination, preventing ~4 million infections after 20 years and ~11 million after 40 years.]]></description><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>AIDS treatment</subject><subject>Analysis</subject><subject>Antiretroviral drugs</subject><subject>CD4-Positive T-Lymphocytes - cytology</subject><subject>Communicable Disease Control</subject><subject>Computer Science</subject><subject>Costs</subject><subject>Drug resistance</subject><subject>Drug Resistance, Viral</subject><subject>Economic aspects</subject><subject>Epidemics</subject><subject>Health Care Costs</subject><subject>Health Services Accessibility</subject><subject>Health Services Needs and Demand - economics</subject><subject>HIV</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - economics</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infectivity</subject><subject>Mathematical models</subject><subject>Medicine</subject><subject>Models, Theoretical</subject><subject>Predictions</subject><subject>Prevalence</subject><subject>Prevention</subject><subject>South Africa</subject><subject>Strategy</subject><subject>World Health Organization</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11rFDEUhgdRbK3-A9EBoVVw13xNZscLoRS1C4WC2t6GM0lmN8vsZM3JFP33Zt3psiO9kFwkJM95T86bnCx7ScmU8pJ-WPk-dNBON76zU0IEZZQ9yo5pxdlEMsIfH6yPsmeIK0IKPpPyaXbEWFWUhLLjLN507s4GhDYHrS1iHn1-Ob_NY7AQ17aL-fa4x7zfg2fRYsyhMzvo7GOaocO1Q3S-e5-b0C_yYNFhhE7b_PRATHuM-Dx70kCL9sUwn2Q3Xz7_uLicXF1_nV-cX020rFicSDKjNbOgC1FZXgspDbCy1AbS1bkhBpq60lpIoQkvSMM4JUYWQEsrtaANP8le73Q3rUc1GIaKciYLISopEjHfEcbDSm2CW0P4rTw49XfDh4WCEJ1urRK64SAKbaQ2wkgBgjR1UZPa1NQSViWtT0O2vl5bo1O5AdqR6Pikc0u18HeKCy4YY0ng7SAQ_M8-eaySpdq2LXTW9-nehM-KipGiTOibf9CHqxuoBaQCXNf4lFdvRdV5ITgnsxmXiZo-QKVh7Nrp9Lsal_ZHAe9GAYmJ9ldcQI-o5t-__T97fTtmTw_YpYU2LtG3fUy_Cseg2IE6eMRgm73JlKhtc9y7obbNoYbmSGGvDh9oH3TfDfwPavUK0Q</recordid><startdate>20120905</startdate><enddate>20120905</enddate><creator>Wagner, Bradley G</creator><creator>Blower, Sally</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20120905</creationdate><title>Universal access to HIV treatment versus universal 'test and treat': transmission, drug resistance & treatment costs</title><author>Wagner, Bradley G ; Blower, Sally</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-6081b2eac549e3b466da277cda0123d0dafb9cc464c0350f2310d65a17e6c41f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>AIDS</topic><topic>AIDS treatment</topic><topic>Analysis</topic><topic>Antiretroviral drugs</topic><topic>CD4-Positive T-Lymphocytes - 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William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Universal access to HIV treatment versus universal 'test and treat': transmission, drug resistance & treatment costs</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-09-05</date><risdate>2012</risdate><volume>7</volume><issue>9</issue><spage>e41212</spage><epage>e41212</epage><pages>e41212-e41212</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ~1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal 'test and treat' (T&T) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a T&T strategy all HIV-infected individuals would receive treatment whether in need or not. This would require treating 5 million individuals almost immediately and providing treatment for several decades. We use a validated mathematical model to predict impact and costs of: (i) a universal T&T strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal T&T strategy in SA would eliminate HIV within a decade, and (after 40 years) cost ~$10 billion less than achieving universal access. In contrast, we predict a universal T&T strategy in SA could eliminate HIV, but take 40 years and cost ~$12 billion more than achieving universal access. We determine the difference in predictions is because the WHO has under-estimated survival time on treatment and ignored the risk of resistance. We predict, after 20 years, ~2 million individuals would need second-line regimens if a universal T&T strategy is implemented versus ~1.5 million if universal access is achieved. Costs need to be realistically estimated and multiple evaluation criteria used to compare 'treatment as prevention' with other prevention strategies. Before implementing a universal T&T strategy, which may not be sustainable, we recommend striving to achieve universal access to treatment as quickly as possible. We predict achieving universal access to treatment would be a very effective 'treatment as prevention' approach and bring the HIV epidemic in SA close to elimination, preventing ~4 million infections after 20 years and ~11 million after 40 years.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22957012</pmid><doi>10.1371/journal.pone.0041212</doi><tpages>e41212</tpages><oa>free_for_read</oa></addata></record> |
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| source | Open Access: PubMed Central; MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science; Free Full-Text Journals in Chemistry; EZB Electronic Journals Library |
| subjects | Acquired immune deficiency syndrome AIDS AIDS treatment Analysis Antiretroviral drugs CD4-Positive T-Lymphocytes - cytology Communicable Disease Control Computer Science Costs Drug resistance Drug Resistance, Viral Economic aspects Epidemics Health Care Costs Health Services Accessibility Health Services Needs and Demand - economics HIV HIV Infections - diagnosis HIV Infections - economics HIV Infections - epidemiology HIV Infections - therapy Human immunodeficiency virus Humans Infectivity Mathematical models Medicine Models, Theoretical Predictions Prevalence Prevention South Africa Strategy World Health Organization |
| title | Universal access to HIV treatment versus universal 'test and treat': transmission, drug resistance & treatment costs |
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