Bold New Strategy to Stop AIDS.11/09

US Federal health officials look at plan to use routine testing and treatment as prevention.

According to a report in the New York Times, “Federal health officials are preparing a plan to study a bold new strategy to stop the spread of the AIDS virus: routinely testing virtually every adult in a community, and promptly treating those found to be infected.
The strategy is called ‘test and treat,’ and officials say the two sites for the three-year study will be the District of Columbia and the Bronx — locales with some of the nation’s highest rates of infection with human immunodeficiency virus (HIV).”

The goal is not to measure whether “test and treat” actually works to slow an epidemic, but whether such a strategy can even be carried out, given the many barriers to being tested and getting medical care. Dr. Shannon L. Hader, director of the HIV/AIDS administration at this city’s Department of Health observed that in the progression from infection to treatment, “we lose people at every single step.” As many as 5% of the adults in the District of Columbia are infected — a rate Dr. Hader says is comparable with those in West Africa — and one-third to one-half do not even know they have the virus. The Centers for Disease Control and Prevention (CDC) reports that nationwide, 20% to 25% of people who are HIV-positive do not know their status.

Even when infection is diagnosed, “getting people from the field to the doctor is the hardest component,” said Angela Fulwood Wood, deputy director of Family and Medical Counseling Service, an agency that operates a mobile HIV testing clinic. Often, she added, someone who has just tested positive “can walk off that day and decide, ‘I’m going to pretend that never happened.’ ”

Researchers planning the study have been meeting with hospital and health officials in Washington and the Bronx to discuss making HIV testing a routine part of visits to doctors, clinics, and emergency rooms.

Last January, Dr. Reuben Granich and colleagues at the World Health Organization (WHO) published a study using mathematical models to predict the effects of universal testing and immediate treatment on a severe HIV epidemic among heterosexuals. They reported that such a policy, if combined with prevention efforts like promotion of condoms and male circumcision, could virtually eliminate transmission of the virus within 10 years.

Community testing programs are likely to attract people who suspect that they might have been exposed to or contracted HIV, but Ms Wood said the key to test and treat would be capturing those who did not volunteer for testing because they did not believe they could be infected —“people who are promiscuous at college, the partygoers, the young professionals who go to the club,” as she put it. She added, “Routine testing at either emergency rooms or physicians’ offices - I think that’s our biggest chance of really catching people earlier.”

So far, no city or country has come close to achieving universal testing for HIV and treatment for all those infected. But researchers and public health officials are eager to test the potential of such a strategy for stemming the epidemic.