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Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?

Sponsor: Human Development Network

EMERGING ISSUES IN TODAY'S HIV RESPONSE:

A DEBATE SERIES
CO-HOSTED BY THE WORLD BANK AND USAID

 

Debate1
Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?

HIV/AIDS Experts Debate the Allocation of HIV-prevention Resources in Africa

Should HIV testing and treating approaches be built into and consume at least 50 percent of resources?

AIDS Red Ribbon

 

Governments, development partners, and communities of people living with HIV and AIDS all agree that the global community must prevent and mitigate the impacts of the HIV epidemic, but few agree on the best course of action—especially when it comes to how to prevent the greatest number of new infections for the lowest cost.

 

One of the possible new approaches to HIV prevention, which is based on a mathematical model, is the “test and treat” strategy. “Test and treat” argues that testing the entire population annually and treating those who tested positive would reduce the infectiousness of all HIV positive persons to the extent that new infections would be minimized and the HIV epidemic would cease.

 

With an audience of hundreds of HIV/AIDS experts in Washington, DC, and by videoconference, in 13 cities in the world, four expert panelists debated the new paradigms around testing and treating.

 

The World Bank and USAID co-hosted the debate on May 19, 2010—the first in a series of HIV/AIDS debates on the constantly changing dynamics of HIV/AIDS, and our collective response. The series will culminate at the 2012 International AIDS Conference in Washington, DC.

 

Panelists included Dr. Norman Hearst, whose research focuses on preventing sexual transmission of HIV and the impact of different prevention strategies in Brazil, Uganda, and Guatemala; Dr. Peter Kilmarx, an expert in epidemiological and clinical research in oral pre-exposure chemoprophylaxis, microbicides, vaccines, prevention of other-to-child transmission, clinical epidemiology, and prevention in healthcare settings; Dr. Julio Montaner, an expert in the development of antiretroviral therapies and management strategies; and Dr. Sally Blower, whose research focuses on developing models of transmission dynamics.

 

Drs. Kilmarx and Montaner, who support expanding the focus on testing and treating, argued that testing is an important part of the intervention, and that it is very effective—and cost-effective—for infected individuals. Treatment and prevention, Dr. Kilmarx said, reduces blood and other viral levels to undetectable levels, thus reducing the likelihood of HIV transmission.

 

Dr. Blower questioned the methodology of studies that conclude that interventions are cost-effective, and cautioned against prematurely shifting money toward testing and treatment without a solid evidence base. Before considering widespread projects, Dr. Hearst added, the global health community must resist efforts to divert prevention funds to treatment.

 

“Test and treat may produce some prevention benefits,” Dr. Hearst said, “but that doesn’t mean that it’s a public health strategy that can or should be implemented.”

 

Both sides agreed that a stronger evidence base on testing and treating would be beneficial, but at what point the world shifts its dollars from prevention to treatment remains unresolved.

 

After the debate ended, audience members said that the debate offered a neutral platform to discuss divergent views, interact with a diverse audience, and spark new thought. Thanks to videoconferencing, it was a rare opportunity to engage with a broad community working in the international HIV/AIDS sphere.

 

Attendees also requested more heat in future debates—continue the debate civility, but discuss the extremes of views. Displaying data graphically, when necessary, also would enhance debates, some said. Overall, though, many deemed the inaugural debate a success.

 

“It was a timely and important topic, [an] excellent choice of moderator and presenters, and very stimulating,” wrote one attendee, who also noted that the challenge is to maintain the momentum with future debates.

 

 

For information on future debates, click here.

 

To learn more about the World Bank’s work in HIV/AIDS, click here.

 

To learn more about USAID’s work in HIV/AIDs, click here.

 

 
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