Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Aug 9;170(15):1347-54.
doi: 10.1001/archinternmed.2010.249.

Comparative effectiveness of HIV testing and treatment in highly endemic regions

Eran Bendavid  1 , Margaret L Brandeau, Robin Wood, Douglas K Owens
Affiliations
Comparative Study

Comparative effectiveness of HIV testing and treatment in highly endemic regions

Eran Bendavid et al. Arch Intern Med. .

Abstract

Background: Universal testing and treatment holds promise for reducing the burden of human immunodeficiency virus (HIV) in sub-Saharan Africa, but linkage from testing to treatment sites and retention in care are inadequate.

Methods: We developed a simulation of the HIV epidemic and HIV disease progression in South Africa to compare the outcomes of the present HIV treatment campaign (status quo) with 4 HIV testing and treating strategies that increase access to antiretroviral therapy: (1) universal testing and treatment without changes in linkage to care and loss to follow-up; (2) universal testing and treatment with improved linkage to care; (3) universal testing and treatment with reduced loss to follow-up; and (4) comprehensive HIV care with universal testing and treatment, improved linkage to care, and reduced loss to follow-up. The main outcome measures were survival benefits, new HIV infections, and HIV prevalence.

Results: Compared with the status quo strategy, universal testing and treatment (1) was associated with a mean (95% uncertainty bounds) life expectancy gain of 12.0 months (11.3-12.2 months), and 35.3% (32.7%-37.5%) fewer HIV infections over a 10-year time horizon. Improved linkage to care (2), prevention of loss to follow-up (3), and comprehensive HIV care (4) provided substantial additional benefits: life expectancy gains compared with the status quo strategy were 16.1, 18.6, and 22.2 months, and new infections were 55.5%, 51.4%, and 73.2% lower, respectively. In sensitivity analysis, comprehensive HIV care reduced new infections by 69.7% to 76.7% under a broad set of assumptions.

Conclusions: Universal testing and treatment with current levels of linkage to care and loss to follow-up could substantially reduce the HIV death toll and new HIV infections. However, increasing linkage to care and preventing loss to follow-up provides nearly twice the benefits of universal testing and treatment alone.

PubMed Disclaimer

Conflict of interest statement

Author Contribution and Conflicts of Interest (Author Form Submitted Separately)

Eran Bendavid:

I participated in originating the concept, in conducting the data collection, construction of the model, and data analysis. I did most of the writing of the paper, including the final revision. I had full access to all of the data in the study and I take responsibility for the integrity of the data and the accuracy of the data analysis. I have no conflicts of interest.

Margaret L. Brandeau:

I participated in elucidating the project’s concept, in conceptualizing the model structure, and revising the manuscript. I have seen and approved the final version and I have no conflicts of interest.

Robin Wood:

I participated in defining the project’s concept, in clarifying issues relating to HIV testing and treatment in South Africa, and in revising the manuscript. I have seen and approved the final version and I have no conflicts of interest.

Douglas K. Owens:

I participated in defining the original concept, in conceptualizing the model, in advising on issues related to outcomes analysis, and in writing and revising the manuscript. I have seen and approved the final version, and I have no conflicts of interest.

Figures

Figure 1
Figure 1
Estimated deaths from HIV over 10 years in South Africa for different HIV testing and treatment strategies. A comparison of the total number of HIV-related deaths over 10 years, by strategy, scaled to South Africa. The error bars represent the 95% confidence bounds from the probabilistic sensitivity analysis.
Figure 2
Figure 2
Projected HIV prevalence in South Africa for different HIV testing and treatment strategies.
Figure 3
Figure 3
Sensitivity analysis of the mortality benefits and reduction in transmission from gradual improvements in linkage to care and prevention of LTFU. Panel A shows the mortality benefits and panel B the reduction in new HIV infections. Each line represents the benefit compared with a universal testing and treatment alone. The relative benefits for improved linkage range over 67%–100% linkage, and for LTFU from 20%-0% loss. The Comprehensive strategy represents simultaneous improvements in linkage and prevention of LTFU. For example, universal testing and treatment with improved linkage to 80% results in a gain of about 2.5 months of life expectancy, or 15% improvement, over universal testing and treatment alone.
See this image and copyright information in PMC

Comment on

References

    1. UNAIDS. Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2008.
    1. UNAIDS. AIDS Epidemic Update. Geneva: Joint United Nations Programme on HIV/AIDS; 2007.
    1. Gregson S, Garnett GP, Nyamukapa CA, et al. HIV decline associated with behavior change in eastern Zimbabwe. Science. 2006;311:664–6. - PubMed
    1. Dixon S, McDonald S, Roberts J. The impact of HIV and AIDS on Africa’s economic development. BMJ. 2002;324:232. - PMC - PubMed
    1. UNAIDS/WHO. Progress Report. Geneva: 2009. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector.

Publication types