ArticlePloS one2012
Universal access to HIV treatment versus universal 'test and treat': transmission, drug resistance & treatment costs.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Promoting HIV care continuum outcomes among people who use drugs and alcohol: a systematic review of randomized trials evaluating behavioral HIV care interventions published from 2011 to 2023.BMC public health · 2023Pooled it
- Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low- and Middle-Income Countries: A Systematic Literature Review.Health economics · 2016Pooled it
- Rapid Initiation of Antiretroviral Therapy Following Diagnosis of Human Immunodeficiency Virus Among Patients with Commercial Insurance Coverage.Journal of managed care & specialty pharmacy · 2020Article
- Article
- "Is it making any difference?" A qualitative study examining the treatment-taking experiences of asymptomatic people living with HIV in the context of Treat-all in Eswatini.Journal of the International AIDS Society · 2019Article
- Drug resistance from preferred antiretroviral regimens for HIV infection in South Africa: A modeling study.PloS one · 2019Article
- Mathematical modelling to inform 'treat all' implementation in sub-Saharan Africa: a scoping review.Journal of virus eradication · 2018Article
- Early antiretroviral therapy and potent second-line drugs could decrease HIV incidence of drug resistance.Proceedings. Biological sciences · 2017Article
- Future technologies for monitoring HIV drug resistance and cure.Current opinion in HIV and AIDS · 2017Review
- The importance of choice disability and structural intervention in the HIV epidemic in Sub-Saharan Africa.PloS one · 2017Article
- HIV Treatment in Resource-Limited Environments: Treatment Coverage and Insights.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2015Article
- Article
- Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa.Southern African journal of HIV medicine · 2015Article
- Creating an African HIV clinical research and prevention trials network: HIV prevalence, incidence and transmission.PloS one · 2015Article
- Are Interferon-Free Direct-Acting Antivirals for the Treatment of HCV Enough to Control the Epidemic among People Who Inject Drugs?PloS one · 2015Article
- Why the proportion of transmission during early-stage HIV infection does not predict the long-term impact of treatment on HIV incidence.Proceedings of the National Academy of Sciences of the United States of America · 2014Article
- What can mathematical models tell us about the relationship between circular migrations and HIV transmission dynamics?Mathematical biosciences and engineering : MBE · 2014Article
- Article
- Expanded HIV testing in low-prevalence, high-income countries: a cost-effectiveness analysis for the United Kingdom.PloS one · 2014Article
- HIV treatment as prevention: contradictory perspectives from dynamic mathematical models.TheScientificWorldJournal · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
Abstract
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.