Voluntary universal annual testing and immediate treatment might have major impact on widespread HIV epidemics
26 November 2008, Geneva — A group of specialists in the World Health Organization (WHO) developed a mathematical model and published findings in the Lancet today to stimulate discussion, debate and further research. The model suggests that using annual, universal voluntary HIV testing followed by immediate ART (irrespective of clinical stage or CD4 count) reduces new cases by 95% within ten years.
The current WHO policy on treatment involves voluntary testing and clinical and/or immunological evaluation (e.g. CD4 count) to determine eligibility for treatment with antiretrovirals.
The authors emphasize the theoretical nature of the exercise based on data and raise a number of concerns regarding feasibility including the protection of individual rights, drug resistance, toxicity and financing challenges.
The paper does not signal a change in WHO guidance. WHO-recommended preventive interventions need to be maintained and expanded. This includes male circumcision, partner reduction, correct and consistent use of condoms, and interventions targeting most-at-risk populations, also known as "combination prevention."
WHO will convene a meeting early next year bringing together ethicists, funders, human rights advocates, clinicians, prevention experts and AIDS programme managers to discuss this and other issues related to the wider use of antiretroviral therapy for HIV prevention.
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