Treatment for Prevention of HIV Transmission in a Localized Epidemic: The Case for South Australia

Noting the ongoing discussion about increasing HIV testing and initiating earlier antiretroviral therapy as a strategy to prevent the spread of the virus, the authors explored the expected epidemiological impact of this approach in a small population where HIV transmission is predominantly confined to men who have sex with men (MSM).

To investigate the impact of strategies that increase rates of testing and treatment, and their likelihood of mitigating HIV epidemics among MSM, a deterministic mathematical transmission model was constructed. "Our novel model distinguishes men in the population who are more easily accessible to prevention campaigns through engagement with the gay community from men who are not," the authors wrote. "This model is applied to the population of MSM in South Australia."

Findings based on the model suggest that increasing testing rates alone will have minimal impact on reducing the expected number of HIV infections, compared to current conditions. "However, in combination with increases in treatment coverage, this strategy could lead to a 59 percent-68 percent reduction in the number of HIV infections over the next five years," the authors wrote. The majority of potential reductions in incidence would result from targeting men who are socially engaged in the gay community, "with only minor improvements possible by reaching all other MSM."

"Investing in strategies that will achieve higher coverage and earlier initiation of treatment to reduce infectiousness of HIV-infected individuals could be an effective strategy for reducing incidence in a population of MSM," the researchers concluded.

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