The Potential Impact of Expanding Antiretroviral Therapy and Combination Prevention in Vietnam: Towards Elimination of HIV Transmission

July 2013 - Combination Prevention

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Kato, M., Granich, R., Duc Bui, D. et al. Journal of Acquired Immune Deficiency Syndromes (2013), E-publication ahead of print.

The authors developed a mathematical model using HIV prevalence data for key populations including people who inject drugs (PWID), men who have sex with men, and female sex workers (FSWs), in addition to male clients of FSWs and low-risk women in Vietnam, to analyze potential benefits of and strategies for increasing access to periodic testing and immediate treatment (PTIT)—routine HIV testing and counseling (HTC) with immediate antiretroviral therapy (ART) initiation if positive—along with other prevention interventions. Thirteen scenarios were analyzed within scenario sets: current intervention levels, PTIT for all adults, PTIT targeted to sub-populations, and policy scenarios (assuming PTIT was implemented in 2011, scaled up, and sustained through 2050). Adding PTIT for key populations, with other combination prevention interventions, had the greatest impact, reducing HIV infections by 81 percent and mortality by 73 percent, and costing only three percent more than current interventions (22.7 million U.S. dollars [U.S.$] versus 22.1 million U.S.$). This scenario would reduce HIV incidence to 1/100,000 in 14 years and obtain annual cost savings after 20 years. By maintaining the current intervention levels from 2011 to 2050, 18,000 people would become infected. Providing annual PTIT to all adults would reduce HIV incidence by 80 percent but at a cost of $76.9 million. PTIT targeted to PWID resulted in the largest decrease in new infections (75 percent) and cost $23.6 million. High- and lower-risk populations should be targeted with different strategies.

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