universal access to hiv treatment versus universal ‘test and treat’ transmission, drug resistance treatment costs普遍获得艾滋病毒治疗和普遍的u201c检测和治疗u201d的传播,耐药和治疗费用.pdf

Universal Access to HIV Treatment versus Universal ‘Test and Treat’: Transmission, Drug Resistance Treatment Costs Bradley G. Wagner, Sally Blower* David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America 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’ (TT) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a TT 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 TT strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal TT 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 TT 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 TT 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 TT strategy, which may