The New England journal of medicine | 2019
HIV-1 Epidemic Control - Insights from Test-and-Treat Trials.
Abstract
Outcomes ranged from no impact on HIV incidence in the South African TasP trial (likely due to suboptimal linkage to care), no impact on HIV incidence in Uganda and Kenya (likely due to the minimal differences in treatment efforts between the intervention and control communities), a 31%-38% reduction in HIV incidence in Botswana, with its statistical significance depending on the statistical analysis used to a 31% reduction in the PopART trial but only in the group with the less intensive treatment intervention. The substantial differences between the results from these community-based trials and those observed in discordant couples, and in ecological observational studies or even those derived from mathematical models may be due largely to the logistical challenges of implementing test and treat at scale. It is therefore unlikely that a testand-treat strategy alone will result in epidemic control.