South Africa: Comparative Effectiveness of HIV Testing and Treatment in Highly Endemic Regions

"Universal testing and treatment holds promise for reducing the burden of [HIV] in sub-Saharan Africa, but linkage from testing to treatment sites and retention in care are inadequate," according to the study's introduction.

The researchers developed an HIV epidemic and disease progression simulation in South Africa to compare the outcomes of the present HIV treatment campaign (status quo) with four HIV testing and treatment strategies that increase access to antiretroviral therapy: (1) universal testing and treatment absent changes in linkage to care and loss to follow-up; (2) universal testing and treatment with enhanced linkage to care; (3) universal testing and treatment with reduced loss to follow-up; and (4) comprehensive HIV care with universal testing and treatment, improved linkage to care and reduced loss the follow-up. Survival benefits, new HIV infections, and HIV prevalence were the main outcome measures.

"Compared with the status quo strategy, universal testing and treatment (1) was associated with a mean (95 percent uncertainty bounds) life expectancy gain of 12.0 months (11.3-12.2 months), and 35.3 percent (32.7 percent-37.5 percent) fewer HIV infections over a 10-year time horizon," the authors reported. Enhanced linkage to care (2), prevention of loss to follow-up (3) and comprehensive HIV care (4) provided substantial additional benefits, they noted: "Life expectancy gains compared with the status quo strategy were 16.1, 18.6 and 22.2 months, and new infections were 55.5 percent, 51.4 percent and 73.2 percent lower, respectively." Sensitivity analysis showed comprehensive HIV care reduced new infections by 69.7 percent to 76.7 percent under a broad set of assumptions.

"Universal testing and treatment with current levels of linkage to care and loss to follow-up could substantially reduce the HIV death toll and new HIV infections," the authors concluded. "However, increasing linkage to care and preventing loss to follow-up provides nearly twice the benefits of universal testing and treatment alone."

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