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Test and treat: strategies for both higher and lower resources settings
S.H. Vermund1, Q. Abdool Karim2,3, S. Eshleman4, D. Donnell5, T. Mastro6, W. El-Sadr7, HIV Prevention Trials Network
1Vanderbilt University School of Medicine, Institute for Global Health, Nashville, TN, United States, 2Columbia University - Mailman School of Public Health, Epidemiology, New York, NY, United States, 3University of KwaZulu-Natal, Durban, South Africa, 4Johns Hopkins School of Medicine, Pathology, Baltimore, MD, United States, 5Fred Hutchinson Cancer Research Center, SCHARP, Seattle, WA, United States, 6Family Health International, Research Triangle Park, NC, United States, 7Columbia University - Mailman School of Public Health, ICAP, New York, NY, United States
Background: Expanded testing and bridging of HIV+ persons to optimized antiretroviral therapy (ART) can reduce community viral load and slow epidemic HIV spread.
Methods: The HIV Prevention Trials Network (HPTN) has launched a family of studies that are designed to optimize strategies essential for HIV control using expanded HIV testing and treatment. We hope these studies will culminate in trials in both North America and southern Africa that test whether expanded testing and treatment reduce HIV transmission.
Results: Active HPTN trials include: HPTN 043, Project Accept: A 48 community randomized trial of expanded HIV testing in 4 nations (T.Coates, chair). HPTN 052/ACTG 5245: A discordant couples study in 8 nations to assess whether early ART initiation reduces HIV transmission to HIV-uninfected partners, and to assess whether early ART benefits HIV+ persons (M.Cohen). HPTN 061, BROTHERS: A feasibility study of US black MSM to identify, engage, and provide services for hard-to-reach persons (B.Koblin, K.Mayer, D.Wheeler). HPTN 064, ISIS: A feasibility study of highest risk US women to assess seroincidence and to engage women in risk reduction programs (S.Hodder, J.Justman). We will present trial design options that will assess the feasibility of large-scale expansion of multi-component interventions with the following elements: testing expansion; “peer navigators” to bridge HIV+ persons into care; “positive prevention” counseling to help HIV+ persons reduce high risk behaviors; staff education to optimize ART; adherence counseling, mnemonics, and outreach with buddy systems, treatment of substance abuse and mental illness; structural interventions to maximize access to risk reduction.
Conclusions: To be effective, a test and treat approach for HIV prevention must be optimized. Failure of any component threatens the integrity of the intervention. The promise of an effective test and treat approach merits intensive investigation to evaluate its benefit to HIV+ persons and its impact on HIV transmission among couples and in communities.
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