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Explore this page to find out more about how HIV treatment is being used as prevention, test and treat strategies , limitations of treatment as prevention and the future of treatment as prevention. Viral suppression can only be confirmed if a person is accessing regular treatment support, monitoring and viral load testing from a healthcare professional.
The effectiveness of ART as a prevention tool is now undisputed — and it is now being used as a public health intervention, as well as a patient-specific strategy. Starting in , the landmark study, HPTN , revealed the personal and public health benefits of early treatment.
This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option. A number of follow-up studies since have also reported significant reductions in HIV transmission, with new infections averted as a result.
The study, which included both heterosexual and gay couples, provides good evidence for the effectiveness of TasP. This evidence for the effectiveness of TasP has led to new World Health Organization WHO guidelines for a 'test and treat' strategy — increasing testing and treatment coverage by initiating all people diagnosed with HIV on ART immediately regardless of their CD4 count or viral load, thereby decreasing community viral load and reducing the rate of new HIV infections.
Testing and treatment levels are also lower among men compared to women and worst in West and Central Africa, the Middle East and North Africa.
A study in South Africa speculates that poor linkage to care may be the biggest obstacle to realising the population-level public health benefits of treatment as prevention. The research took place in a rural area of KwaZulu-Natal, where three in ten people are living with HIV — the highest prevalence in South Africa — and examined the population impact of scaling up treatment as prevention.
Despite increasing access to HIV testing and getting people who were on treatment virally suppressed, the results revealed that those diagnosed often did not link to medical care, or took many months to do so. Trials testing the effectiveness of treatment as prevention for the general population in high HIV prevalence settings are ongoing.
A study in India among men who have sex with men and people who inject drugs found a clear correlation between treatment, viral suppression and HIV incidence in large populations — although long-term follow up is needed. For example, people in the study expressed different levels of readiness when it came to engaging with HIV services; some were slower than others to move from contemplating treatment to starting and staying on the treatment cascade — with some not necessarily ready for treatment immediately after testing.
Stigma, discrimination and other human rights violations deter people from seeking testing and treatment and also compromise their ability to adhere to ART. Findings from a study looking at the use of ART alongside PrEP for mixed-status heterosexual couples from Kenya and Uganda found the combination of these two tools to have a strong preventative impact for HIV.
The success of treatment as prevention is highly dependent upon people adhering to their treatment. It is widely agreed that once treatment is initiated it should not be interrupted. Incomplete viral suppression causes the more sensitive strains of HIV to be suppressed and the resistant strains, which are harder to treat, to become dominant.
The study in Cape Town, South Africa, examined the success of community adherence clubs, consisting of between 25 and 30 people, which were led by community health workers and supported by nurses. The clubs met every two months for group counselling, a brief symptom screening, and distribution of pre-packed ART. There are also concerns that the widespread use of antiretroviral treatment at a population level to reduce the number of new HIV infections could lead to a significant increase in levels of HIV drug resistance HIVDR , as a result of poor adherence and treatment interruptions.
It is therefore vital that patient and programmatic factors that can lead to HIVDR are monitored, so the potential impact of drug resistance for the response can be mitigated.
Studies have shown that, when PrEP is adhered to exactly as prescribed, it reduces the chances of HIV infection to near-zero. However, if not taken consistently, PrEP is much less effective and the risk of HIV infection increases substantially.
It also does not provide protection against other sexually transmitted infections STIs and blood-borne illnesses such as hepatitis C, syphilis, and gonorrhoea. For people who inject drugs, using clean needles each and every time will prevent infection from both HIV and other blood borne illnesses, such as hepatitis. As a result, it is important that PrEP is offered as part of a combination package of prevention initiatives based on individual circumstances.
Previously, it was only recommended for certain key affected populations such as sex workers , men who have sex with men and people who inject drugs. Microbicides are gels or creams containing antiretroviral drugs that are applied to the vagina to help prevent HIV infection. Vaginal microbicides are relatively effective, so long as they are used consistently and correctly. In this respect, the issues for microbicides and PrEP are comparable.
In both studies, women aged over 21 used the ring more consistently and so more women in this age group were protected from HIV. However, there was little impact on HIV incidence in women aged as this age group was less likely to consistently adhere to the ring. Since , it has been used by healthcare workers who may have been exposed to HIV-infected fluids.
Treatment as prevention has the potential to radically change the global response to HIV. Increasing uptake of HIV testing, offering treatment and linking people to care will reduce population level rates of HIV transmission. Innovative strategies to increase the number of people testing for HIV, such as self-testing and partner-supported testing services, must be expanded.
Along with strategies that increase treatment adherence, such as cash transfers. Without this, the benefits of this powerful new set of preventative tools will be lost. This progress has however been uneven with some regions achieving far higher viral suppression rates than others.
There also needs to be a comprehensive package of prevention methods including HIV and sexual and reproductive health education, condom use, stigma reduction and behaviour change to reduce the amount of new infection in the first place.
You are here Home. Evidence has now shown that individuals on effective antiretroviral treatment ART with an undetectable viral load cannot transmit HIV to others. Treatment as prevention TasP will only be effective alongside the scale up of testing programmes and ART adherence support. Would you like to comment on this page? Leave this field blank.