Khademi, A., Anand, S. and Potts, D. Medicine (September 2015), 94(37):e1453, doi: 10.1097/MD.0000000000001453.
The authors of this study developed an analytical framework to estimate the effects of scaling up HIV education and providing universal access to treatment on HIV incidence, prevalence, and mortality. Using demographic and epidemiologic data from South Africa, they compared the HIV prevalence generated by the model with the actual HIV prevalence observed in South Africa from 1990 to 2000. The results showed that combining expanded HIV education and universal access to treatment significantly decreased both incidence rates (declining from 2.3% to 0.6%) and prevalence (declining from 15.1% to 9.3%) over the course of 15 years. Thus, the benefit of a combined strategy of universal access to treatment and HIV education scale-up was greater than the benefit of the two strategies implemented individually. The combined strategy decreased the incidence rate by 74 percent over the course of 15 years, whereas universal access to treatment and HIV education scale-up separately decreased incidence by 43 percent and 8 percent, respectively. Additionally, universal access to treatment alone averted 7,596,439 deaths, whereas combining universal access with HIV education scale-up averted 7,679,917 deaths over 15 years. The authors concluded that comprehensive combination prevention might have a larger impact on containing the epidemic than implementing separate prevention programs. They recommended designing effective combination prevention programs in sub-Saharan Africa.