Implementing the 'test-and-treat' strategy in Washington DC, a new study suggests, may reduce instances of HIV although eliminating the epidemic will not be possible.
In 2009, WHO scientists had suggested that a voluntary system of annual HIV testing of all adults, followed by immediate provision of ART (antiretroviral treatment) for those testing positive, "could nearly stop transmission and drive HIV into an elimination phase."
Following this, The National Institute for Allergy and Infectious Diseases (NIAID) recently announced a two-year, $26.4 million partnership with the Washington, DC, Department of Health that includes a pilot study of the test-and-treat strategy.
However, experts remain unconvinced.
"The reality of HIV screening programs, even the best ones, is that many people are never reached for screening, some refuse screening or do not link to care, and many of those who are treated do not maintain viral suppression," notes Kenneth A. Freedberg, MD, MSc, of the MGH Department of Medicine, the report's senior author.
"The benefits of expanded testing to persons with undiagnosed HIV infection are unquestioned," says Rochelle P. Walensky, MD, MPH, of the Massachusetts General Hospital (MGH) Division of Infectious Disease.
"Earlier detection and linkage to care saves lives; this alone is a reason for test-and-treat. But pinning all our hopes on the latest 'magic bullet,' underestimating the logistical obstacles, and forgetting that prevention requires an integrated package of strategies puts us at risk of falling into a trap we've seen before.
"Our analysis suggests that test-and-treat will likely be a very important addition to the treatment and prevention armamentarium, but the expectations for its impact should be realistic," he said.
The paper will appear in the August 15 issue of Clinical Infectious Diseases.