In 2011, the Ministry of Health in Swaziland joined forces with the WHO, the Global Fund and SACEMA to do the first in depth health programmes progress evaluation using triangulation from key empirical data sources. The focus was on key questions like: Given increasing coverage of ART, has ART reduced adult and/or infant mortality?; Can TB trends be related to trends in HIV prevalence, ART coverage and combined TB/HIV interventions?; Can trends in infant mortality be related to uptake of PMTCT?
Eastern and southern Africa remains the region most affected by the HIV epidemic in the world and accounts for more than 50% of the global burden of HIV. Significant progress has been made in recent years in the response to the epidemic in the region: new HIV infections and AIDS deaths have fallen while prevention and treatment services for HIV have increased substantially. While several challenges still remain, there is renewed optimism that the elimination of HIV and AIDS is not an impossible goal.
Using a catalytic model no significant reduction of HIV incidence was found despite increasing ART coverage.
Antiretroviral treatment should be a patient-doctor choice available to all upon diagnosis.
The contributions in this issue of the SACEMA Quarterly focus on different aspects related to TB and incidence of HIV. This editorial focuses on HIV treatment as prevention by presenting the MaxART project (Maximizing ART for Better Health and Zero New HIV Infections). This project pursues the dream of reaching all people in Swaziland who are in need of treatment with an ultimate goal of preparing the country for the possibility of ending the HIV epidemic. SACEMA is one of the members of the MaxART consortium and is involved in various modelling and analysis activities that are presented here.
On June 19, 2012, SACEMA’s Brian Williams, also Senior Technical Adviser to Test & Treat to End AIDS, held a briefing in Washington DC in which he explained to US senators, members of congress, and staff how this strategy has the potential to stop the spread of HIV/AIDS and, over time, to save billions of Read More
A recent randomized controlled trial demonstrated that antiretroviral therapy (ART) prevents HIV transmission. In successfully treated patients the HI virus in the blood is suppressed to undetectable levels and therefore the probability of transmitting the virus is extremely low. This new finding must be incorporated into the evaluation of the advantages and disadvantages of different ART provision strategies. The optimal strategy for monitoring treatment response and detecting treatment failure – routine viral load monitoring (rVL) or CD4 cell counts or clinical symptoms – has been the subject of continuous debate. We suspected that rVL could potentially prevent HIV transmission by making it easier to detect treatment failure earlier. We developed a mathematical simulation model to estimate potential transmission from 1,000 patients treated with ART with either rVL or CD4 monitoring.
We need to move from theory to practice and fund, implement and evaluate the test-and-treat strategy.
In order to assess the effects of Treatment as Prevention (TaP) on HIV incidence, results from HIV testing over time need to be available. This links to two aspects of information retention – data storage and data usage – which are discussed and illustrated by the case of HIV testing data in this editorial.
Observational studies suggest that sexual transmission of HIV may be lower in couples in which one partner is infected with HIV and the other is not (HIV-discordant couples) if the infected partner is on antiretroviral therapy (ART). If ART does confer a prevention benefit, in addition to its well established therapeutic efficacy, it may be an indication to initiate treatment earlier than currently recommended. Recently a systematic review was conducted on the issue and based on the evidence provided by one randomised controlled trial and seven observational cohort studies, ART has been shown to be a potent intervention for prevention of HIV in discordant couples. More results of the review are reported here, as well as the implications for practice and research.