ArticleThe Lancet. Infectious diseases2016
Testing the hypothesis that treatment can eliminate HIV: a nationwide, population-based study of the Danish HIV epidemic in men who have sex with men.
Article in The Lancet. Infectious diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Prospects of HIV elimination among men who have sex with men: A systematic review of modeling studies.PLoS computational biology · 2026Pooled it
- A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men.AIDS and behavior · 2019Pooled it
- A cluster-randomized controlled trial of a combination HIV risk reduction and economic empowerment intervention for women engaged in sex work in Uganda.Journal of the International AIDS Society · 2025Trial
- A modeling study of pre-exposure prophylaxis to eliminate HIV in Taiwan by 2030.Communications medicine · 2025Article
- Predictors of HIV Among 1 Million Clients in High-Risk Male Populations in Tanzania.AIDS and behavior · 2022Article
- Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities.AIDS and behavior · 2022Article
- Length of stay in Denmark before HIV diagnosis and linkage to care: a population-based study of migrants living with HIV, Denmark, 1995 to 2020.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2022Article
- HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys.PloS one · 2021Article
- Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012-2016.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice.Frontiers in communication · 2020Article
- An exploratory assessment of the preference for eHealth interventions to prevent HIV and sexually transmitted infections among men who have sex with men in Hanoi, Vietnam.BMC public health · 2020Article
- Treatment as Prevention: Concepts and Challenges for Reducing HIV Incidence.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Sexually transmitted infections and HIV in the era of antiretroviral treatment and prevention: the biologic basis for epidemiologic synergy.Journal of the International AIDS Society · 2019Review
- Earlier Initiation of Antiretroviral Treatment Coincides With an Initial Control of the HIV-1 Sub-Subtype F1 Outbreak Among Men-Having-Sex-With-Men in Flanders, Belgium.Frontiers in microbiology · 2019Article
- Healthcare providers' knowledge, readiness, prescribing behaviors, and perceived barriers regarding routine HIV testing and pre-exposure prophylaxis in DeLand, Florida.SAGE open medicine · 2019Article
- HIV, HCV and HBV: A Review of Parallels and Differences.Infectious diseases and therapy · 2018Review
- A modeling study of the Danish HIV epidemic in men who have sex with men: travel, pre-exposure prophylaxis and elimination.Scientific reports · 2018Article
- Article
- HIV Prevention Efforts and Incidence of HIV in Uganda.The New England journal of medicine · 2017Article
- Using geospatial mapping to design HIV elimination strategies for sub-Saharan Africa.Science translational medicine · 2017Article
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundWorldwide, approximately 35 million individuals are infected with HIV; about 25 million of these live in sub-Saharan Africa. WHO proposes using treatment as prevention (TasP) to eliminate HIV. Treatment suppresses viral load, decreasing the probability an individual transmits HIV. The elimination threshold is one new HIV infection per 1000 individuals. Here, we test the hypothesis that TasP can substantially reduce epidemics and eliminate HIV. We estimate the impact of TasP, between 1996 and 2013, on the Danish HIV epidemic in men who have sex with men (MSM), an epidemic UNAIDS has identified as a priority for elimination.
methodsWe use a CD4-staged Bayesian back-calculation approach to estimate incidence, and the hidden epidemic (the number of HIV-infected undiagnosed MSM). To develop the back-calculation model, we use data from an ongoing nationwide population-based study: the Danish HIV Cohort Study.
findingsIncidence, and the hidden epidemic, decreased substantially after treatment was introduced in 1996. By 2013, incidence was close to the elimination threshold: 1·4 (median, 95% Bayesian credible interval [BCI] 0·4-2·1) new HIV infections per 1000 MSM and there were only 617 (264-858) undiagnosed MSM. Decreasing incidence and increasing treatment coverage were highly correlated; a treatment threshold effect was apparent.
interpretationOur study is the first to show that TasP can substantially reduce a country's HIV epidemic, and bring it close to elimination. However, we have shown the effectiveness of TasP under optimal conditions: very high treatment coverage, and exceptionally high (98%) viral suppression rate. Unless these extremely challenging conditions can be met in sub-Saharan Africa, the WHO's global elimination strategy is unlikely to succeed.
fundingNational Institute of Allergy and Infectious Diseases.
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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.