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Nurturing the Continuum of HIV Testing, Treatment and Prevention Matrix Cascade in Reducing HIV Transmission

Clarence S Yah1

  • 1Implementation Science Unit, Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Ethiopian Journal of Health Sciences
|March 1, 2018
PubMed

Insights

Treating all individuals with HIV, regardless of CD4 count, and providing prevention for high-risk partners significantly reduces HIV transmission. This approach is key to controlling HIV incidence and improving health outcomes.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • HIV morbidity, mortality, and infections continue to rise despite expanded antiretroviral therapy (ART) eligibility.
  • Current ART eligibility criteria have shifted from CD4 ≤ 200 to CD4 ≤ 500 cells/mm³.
  • A paradigm shift towards treating all HIV-positive individuals is proposed to mitigate HIV-related illnesses.

Purpose of the Study:

  • To evaluate the impact of universal HIV treatment and prevention strategies on HIV incidence.
  • To assess the effectiveness of providing ART to all HIV-positive individuals irrespective of CD4 count.
  • To determine the role of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for high-risk HIV-negative partners.

Main Methods:

  • A literature review was conducted to identify evidence-based ART and HIV prevention interventions.
  • Included studies were published in English and indexed in major journals.
  • A mathematical model was used to simulate HIV incidence, assuming a baseline rate of 1.2 per 100 person-years.

Main Results:

  • HIV transmission was reduced from 1.2 to 1.032 per 100 person-years within 6 months in the model.
  • The model indicated a significant reduction in HIV incidence.
  • The combined protective effect of ART for HIV-positive partners and PrEP/PEP for HIV-negative partners demonstrated an 86% probability of preventing transmission.

Conclusions:

  • Implementing universal ART for all HIV-positive individuals and prevention strategies for high-risk partners can significantly reduce HIV incidence.
  • This integrated approach is crucial for controlling HIV transmission and reducing HIV-related morbidity and mortality.
  • Sustained adoption of these policies may lead to better control of HIV genotypes and opportunistic infections.
Abstract

Keywords:
HIVincidencelinkage to carepreventiontest and treat

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