McNairy, M.L., M. Cohen, & W.M. El-Sadr. Current HIV/AIDS Reports (January 2013), e-publication ahead of print.
The authors discussed “treatment as prevention” (TasP) in the framework of a combination intervention: HIV testing, linkage to care, retention in care, and adherence. TasP can increase demand for testing, expand testing services, and improve linkage and retention in care and adherence to treatment, yet the challenge is to improve each component to attain effectiveness. Several modeling studies have suggested that TasP can potentially eliminate HIV in a high-burden setting. However, testing coverage, linkage and retention in care rates, and ART adherence are substantially lower in real settings, highlighting that each element needs strengthening. HIV testing is the entry point for TasP, while linkage to care is considered the weakest component in the continuum of care. TasP requires life-long retention in care, unlike other biomedical prevention interventions. TasP as a combination prevention intervention needs to be tailored to contexts and populations, and it may impact the greater health system. Integrated prevention and care services for high-risk groups may achieve positive results in reducing risk behaviors. In one study the authors discussed, Gardner et al. (2011) found only trivial improvements in viral load suppression when improving only one element in the continuum of care; however, with improvements across all elements, viral load suppression increased from 19 percent to 66 percent. The authors concluded that only by strengthening each component can TasP achieve impact at the population level.