Universal Access to HIV Treatment versus Universal ‘Test and Treat’: Transmission, Drug Resistance & Treatment Costs
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{"title"=>"Universal Access to HIV Treatment versus Universal 'Test and Treat': Transmission, Drug Resistance & Treatment Costs", "type"=>"journal", "authors"=>[{"first_name"=>"Bradley G.", "last_name"=>"Wagner", "scopus_author_id"=>"34878118800"}, {"first_name"=>"Sally", "last_name"=>"Blower", "scopus_author_id"=>"7006330083"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"365608774", "sgr"=>"84866006208", "issn"=>"19326203", "pmid"=>"22957012", "scopus"=>"2-s2.0-84866006208", "doi"=>"10.1371/journal.pone.0041212", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)"}, "id"=>"6265233f-53cd-3130-8775-0366e2f563ba", "abstract"=>"In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ~1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal 'test and treat' (T&T) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a T&T strategy all HIV-infected individuals would receive treatment whether in need or not. This would require treating 5 million individuals almost immediately and providing treatment for several decades. We use a validated mathematical model to predict impact and costs of: (i) a universal T&T strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal T&T strategy in SA would eliminate HIV within a decade, and (after 40 years) cost ~$10 billion less than achieving universal access. In contrast, we predict a universal T&T strategy in SA could eliminate HIV, but take 40 years and cost ~$12 billion more than achieving universal access. We determine the difference in predictions is because the WHO has under-estimated survival time on treatment and ignored the risk of resistance. We predict, after 20 years, ~2 million individuals would need second-line regimens if a universal T&T strategy is implemented versus ~1.5 million if universal access is achieved. Costs need to be realistically estimated and multiple evaluation criteria used to compare 'treatment as prevention' with other prevention strategies. Before implementing a universal T&T strategy, which may not be sustainable, we recommend striving to achieve universal access to treatment as quickly as possible. We predict achieving universal access to treatment would be a very effective 'treatment as prevention' approach and bring the HIV epidemic in SA close to elimination, preventing ~4 million infections after 20 years and ~11 million after 40 years.", "link"=>"http://www.mendeley.com/research/universal-access-hiv-treatment-versus-universal-test-treat-transmission-drug-resistance-treatment-co-7", "reader_count"=>60, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>1, "Student > Doctoral Student"=>5, "Researcher"=>16, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>4, "Student > Master"=>16, "Other"=>1, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>1, "Student > Doctoral Student"=>5, "Researcher"=>16, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>4, "Student > Master"=>16, "Other"=>1, "Student > Bachelor"=>5, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>1, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Agricultural and Biological Sciences"=>4, "Arts and Humanities"=>1, "Business, Management and Accounting"=>2, "Economics, Econometrics and Finance"=>2, "Engineering"=>2, "Nursing and Health Professions"=>3, "Biochemistry, Genetics and Molecular Biology"=>2, "Mathematics"=>1, "Medicine and Dentistry"=>33, "Design"=>1, "Psychology"=>1, "Social Sciences"=>5}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>33}, "Social Sciences"=>{"Social Sciences"=>5}, "Psychology"=>{"Psychology"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>3}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Design"=>{"Design"=>1}, "Engineering"=>{"Engineering"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "reader_count_by_country"=>{"United States"=>2, "Tanzania"=>1, "Brazil"=>1, "Uganda"=>1, "United Kingdom"=>1, "Switzerland"=>4}, "group_count"=>3}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/4430980"], "description"=>"<p>Dynamics of acquired and transmitted drug resistance are included in these simulations. To generate this figure we assumed a treatment-induced reduction in infectivity of 85%, acquired drug resistance develops in treated individuals at a rate of 3% per year <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041212#pone.0041212-Granich2\" target=\"_blank\">[10]</a> and drug-resistant strains are 50% as transmissible as wild-type strains. Panel (<b>A</b>) shows annual incidence over time. The blue curve shows wild-type incidence if the T&T strategy is implemented; black curve shows wild-type incidence if universal access to treatment is achieved. The red dashed curve shows the maximum incidence of transmitted drug resistance if either universal access is achieved or the T&T strategy is implemented. Panel (<b>B</b>) shows the number of infections prevented over time for the T&T strategy (blue curve) and if universal access to treatment (black curve) is achieved. Panel (<b>C</b>) shows the number of individuals in need of treatment over time. Blue and red curves represent the T&T strategy; the blue curve shows the number of individuals in need of first-line regimens, the solid red curve shows the number in need of second-line regimens. Black and orange curves represent achieving universal access to treatment; the black curve shows the number in need of first-line regimens, the orange curve shows the number in need of second-line regimens.</p>", "links"=>[], "tags"=>["40 years", "access", "strategy", "individual", "SA", "HIV", "20 years"], "article_id"=>252643, "categories"=>["Medicine", "Microbiology", "Biotechnology", "Evolutionary Biology", "Environmental Sciences not elsewhere classified", "Ecology", "Cancer", "Science Policy", "Infectious Diseases", "Plant Biology"], "users"=>["Bradley G. Wagner", "Sally Blower"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0041212.g004"], "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Predictions_for_South_Africa_from_our_transmission_model_if_universal_access_to_treatment_is_achieved_or_a_universal_T_amp_T_with_annual_testing_strategy_is_implemented_/252643", "title"=>"Predictions for South Africa from our transmission model if universal access to treatment is achieved or a universal T&T (with annual testing) strategy is implemented.", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-09-05 14:10:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/4430977"], "description"=>"<p>Costs are discounted by 3.5% annually, following Granich <i>et al.</i> <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041212#pone.0041212-Granich2\" target=\"_blank\">[10]</a>. The dynamics of acquired and transmitted drug resistance are not included in these simulations. Solid lines denote the case where the treatment-induced reduction in infectivity is 96% and dashed lines denote the case where the reduction is 85%. Panels show (<b>A</b>) discounted annual treatment costs over time and (<b>B</b>) discounted cumulative treatment costs over time. The dynamics of acquired and transmitted drug resistance are not included in these simulations.</p>", "links"=>[], "tags"=>["40 years", "access", "strategy", "individual", "SA", "HIV", "20 years"], "article_id"=>252527, "categories"=>["Medicine", "Microbiology", "Biotechnology", "Evolutionary Biology", "Environmental Sciences not elsewhere classified", "Ecology", "Cancer", "Science Policy", "Infectious Diseases", "Plant Biology"], "users"=>["Bradley G. Wagner", "Sally Blower"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0041212.g003"], "stats"=>{"downloads"=>0, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_of_the_universal_8216_test_and_treat_8217_T_amp_T_strategy_blue_curves_and_achieving_universal_access_to_treatment_black_curves_in_terms_of_discounted_treatment_costs_/252527", "title"=>"Comparison of the universal ‘test and treat’ (T&T) strategy (blue curves) and achieving universal access to treatment (black curves) in terms of discounted treatment costs.", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-09-05 14:10:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/4430950", "https://ndownloader.figshare.com/files/4430953", "https://ndownloader.figshare.com/files/4430956", "https://ndownloader.figshare.com/files/4430959", "https://ndownloader.figshare.com/files/4430962"], "description"=>"<div><p>In South Africa (SA) universal access to treatment for HIV-infected individuals in need has yet to be achieved. Currently ∼1 million receive treatment, but an additional 1.6 million are in need. It is being debated whether to use a universal ‘test and treat’ (T&T) strategy to try to eliminate HIV in SA; treatment reduces infectivity and hence transmission. Under a T&T strategy all HIV-infected individuals would receive treatment whether in need or not. This would require treating 5 million individuals almost immediately and providing treatment for several decades. We use a validated mathematical model to predict impact and costs of: (i) a universal T&T strategy and (ii) achieving universal access to treatment. Using modeling the WHO has predicted a universal T&T strategy in SA would eliminate HIV within a decade, and (after 40 years) cost ∼$10 billion <u>less</u> than achieving universal access. In contrast, we predict a universal T&T strategy in SA could eliminate HIV, but take 40 years and cost ∼$12 billion <u>more</u> than achieving universal access. We determine the difference in predictions is because the WHO has under-estimated survival time on treatment and ignored the risk of resistance. We predict, after 20 years, ∼2 million individuals would need second-line regimens if a universal T&T strategy is implemented versus ∼1.5 million if universal access is achieved. Costs need to be realistically estimated and multiple evaluation criteria used to compare ‘treatment as prevention’ with other prevention strategies. Before implementing a universal T&T strategy, which may not be sustainable, we recommend striving to achieve universal access to treatment as quickly as possible. We predict achieving universal access to treatment would be a very effective ‘treatment as prevention’ approach and bring the HIV epidemic in SA close to elimination, preventing ∼4 million infections after 20 years and ∼11 million after 40 years.</p></div>", "links"=>[], "tags"=>["40 years", "access", "strategy", "individual", "SA", "HIV", "20 years"], "article_id"=>120477, "categories"=>["Medicine", "Microbiology", "Biotechnology", "Evolutionary Biology", "Environmental Sciences not elsewhere classified", "Ecology", "Cancer", "Science Policy", "Infectious Diseases", "Plant Biology"], "users"=>["Bradley G. Wagner", "Sally Blower"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0041212.s001", "https://dx.doi.org/10.1371/journal.pone.0041212.s002", "https://dx.doi.org/10.1371/journal.pone.0041212.s003", "https://dx.doi.org/10.1371/journal.pone.0041212.s004", "https://dx.doi.org/10.1371/journal.pone.0041212.s005"], "stats"=>{"downloads"=>10, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Universal_Access_to_HIV_Treatment_versus_Universal_Test_and_Treat_Transmission_Drug_Resistance_Treatment_Costs/120477", "title"=>"Universal Access to HIV Treatment versus Universal ‘Test and Treat’: Transmission, Drug Resistance & Treatment Costs", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-09-05 14:10:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/4430986"], "description"=>"<p>Costs are discounted by 3.5% annually, following Granich <i>et al.</i> <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041212#pone.0041212-Granich2\" target=\"_blank\">[10]</a>. Dynamics of acquired and transmitted drug resistance are included in these simulations. To generate this Figure we assumed a treatment-induced reduction in infectivity of 85%, acquired drug resistance develops in treated individuals at a rate of 3% per year <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0041212#pone.0041212-Granich2\" target=\"_blank\">[10]</a> and drug-resistant strains are 50% as transmissible as wild-type strains. Panel (<b>A</b>) shows discounted annual treatment costs over time and (<b>B</b>) shows discounted cumulative treatment costs over time. Treatment costs include the costs for both first-line and second-line regimens.</p>", "links"=>[], "tags"=>["40 years", "access", "strategy", "individual", "SA", "HIV", "20 years"], "article_id"=>252729, "categories"=>["Medicine", "Microbiology", "Biotechnology", "Evolutionary Biology", "Environmental Sciences not elsewhere classified", "Ecology", "Cancer", "Science Policy", "Infectious Diseases", "Plant Biology"], "users"=>["Bradley G. Wagner", "Sally Blower"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0041212.g005"], "stats"=>{"downloads"=>0, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_of_the_costs_of_the_universal_8216_test_and_treat_8217_T_amp_T_strategy_blue_curve_and_achieving_universal_access_to_treatment_black_curve_in_terms_of_discounted_treatment_costs_/252729", "title"=>"Comparison of the costs of the universal ‘test and treat’ (T&T) strategy (blue curve) and achieving universal access to treatment (black curve) in terms of discounted treatment costs.", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-09-05 14:10:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/4430965"], "description"=>"<p>The dotted black line represents the threshold R<sub>c</sub> = 1; below this threshold (i.e., R<sub>c</sub><1) elimination is (theoretically) possible. Panels represent the average treatment-induced reduction in infectivity at the population level: (<b>A</b>) 96% (<b>B</b>) 90% (<b>C</b>) 85%.</p>", "links"=>[], "tags"=>["40 years", "access", "strategy", "individual", "SA", "HIV", "20 years"], "article_id"=>2749111, "categories"=>["Medicine", "Microbiology", "Biotechnology", "Evolutionary Biology", "Environmental Sciences not elsewhere classified", "Ecology", "Cancer", "Science Policy", "Infectious Diseases", "Plant Biology"], "users"=>["Bradley G. Wagner", "Sally Blower"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0041212.g001", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Dependence_of_the_Control_Reproduction_Number_R_sub_c_sub_on_the_average_population_level_testing_frequency_for_HIV_in_terms_of_years_between_tests_and_the_treatment_initiation_threshold_in_terms_of_the_CD4_cells_L_/2749111", "title"=>"Dependence of the Control Reproduction Number (R<sub>c</sub>) on the average population-level testing frequency for HIV (in terms of years between tests) and the treatment initiation threshold in terms of the CD4 cells/µL.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-09-05 14:10:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/4430971"], "description"=>"<p>The dynamics of acquired and transmitted drug resistance are not included in these simulations. Solid lines denote the case where the treatment-induced reduction in infectivity is 96% and dashed lines denote the case where the reduction is 85%. Panels show (<b>A</b>) annual incidence over time, (<b>B</b>) number of infections prevented over time and (<b>C</b>) number of individuals in need of treatment over time.</p>", "links"=>[], "tags"=>["40 years", "access", "strategy", "individual", "SA", "HIV", "20 years"], "article_id"=>252485, "categories"=>["Medicine", "Microbiology", "Biotechnology", "Evolutionary Biology", "Environmental Sciences not elsewhere classified", "Ecology", "Cancer", "Science Policy", "Infectious Diseases", "Plant Biology"], "users"=>["Bradley G. Wagner", "Sally Blower"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0041212.g002"], "stats"=>{"downloads"=>0, "page_views"=>34, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Predictions_for_South_Africa_generated_from_our_transmission_model_if_universal_access_to_treatment_is_achieved_black_curves_or_a_universal_T_amp_T_with_annual_testing_strategy_blue_curves_is_implemented_/252485", "title"=>"Predictions for South Africa generated from our transmission model if universal access to treatment is achieved (black curves) or a universal T&T (with annual testing) strategy (blue curves) is implemented.", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2012-09-05 14:10:25"}

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Relative Metric

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