hiv treatment as prevention natural experiments highlight limits of antiretroviral treatment as hiv prevention艾滋病毒治疗和预防自然抗逆转录病毒治疗的艾滋病毒预防实验强调限制.pdfVIP

Review HIV Treatment as Prevention: Natural Experiments Highlight Limits of Antiretroviral Treatment as HIV Prevention David P. Wilson* The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia discussing operational issues about how to implement treatment Abstract: There is growing enthusiasm for increasing as prevention [12]. coverage of antiretroviral treatment among HIV-infected We do not need to wait for trials of increased ART coverage to people for the purposes of preventing ongoing transmis- be completed, or speculate through the use of mathematical sion. Treatment as prevention will face a number of models, to have some understanding of the likely population-level barriers when implemented in real world populations, impact of this strategy. Treatment as prevention has essentially which will likely lead to the effectiveness of this strategy been implemented in some settings already for a considerable being lower than proposed by optimistic modelling scenarios or ideal clinical trial settings. Some settings, as time. Planned treatment-as-prevention approaches involve fre- part of their prevention and treatment strategies, have quent universal testing and initiation of ART early post-diagnosis, already attained rates of HIV testing and use of but increasing treatment coverage at any stage