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How To End HIV in Africa

How To End HIV in Africa

A realistic model predicts HIV to be eliminated in 17 years.

South Africa is known to have a major burden of HIV infection cases. As Pieter Fourie put it in 2006: “AIDS is killing South Africans at a rate equivalent to one September 11th attack every three days”. The situation still is as serious as this: life expectancy should have reached 64 years by now, but with the HIV pandemic it has regressed to about 47 years. It is known that women are more easily infected than men and that most of these infected women are in their twenties.

Nowadays, antiretroviral therapy (ART) is being used as treatment for HIV, however, it is only applied in an individual-manner and only comprises individuals whose CD4 count falls below 350 cells/µl in blood.

Therapy for all

Recently, it has been proposed that expanded access to antiretroviral therapy for all people tested positive for HIV would at least impair the infectiousness and consequently reduce the incidence. Actually, a mathematical modeling study of Granich et al. predicted that this could widely reduce HIV in a 7-year window of time.

This specific time frame is not corroborated by other studies, even though they all demonstrate the possibility of eliminating HIV in South Africa (less than one new infection per 1,000 person/year). Hontelez et al., for example, analyzed several mathematical models and papers and found that parameters for the success resumed to universal testing and immediate initiation of treatment (UTT) for 90% of the HIV positive.  He does estimate a longer period of time than Granich et al., with the most realistic model predicting HIV to be eliminated in 17 years.

Remains to know if personal aspects were considered in these models. We have to admit that not everyone is willing to be tested, as previous studies suggested, about 3-33% of people refuse to give a blood sample to test. It is important to point out that the current strategy towards reduction of HIV infections has already great results, but it is predicted to take much longer (27 years) than the ART plus UTT method.

Reference:
Hontelez JA, Lurie MN, Bärnighausen T, Bakker R, Baltussen R, Tanser F, Hallett TB, Newell ML, & de Vlas SJ (2013). Elimination of HIV in South Africa through Expanded Access to Antiretroviral Therapy: A Model Comparison Study. PLoS medicine, 10 (10) PMID: 24167449
Ford N, & Hirnschall G (2013). Modelling the Strategic Use of Antiretroviral Therapy for the Treatment and Prevention of HIV. PLoS medicine, 10 (10) PMID: 24167450
Granich RM, Gilks CF, Dye C, De Cock KM, & Williams BG (2009). Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet, 373 (9657), 48-57 PMID: 19038438
Nattrass, N. (2006) The Moral Economy of AIDS in South Africa. Cambridge University Press. ISBN: 9780521548649
The Political management of HIV and AIDS in South Africa : one burden too many? http://minerva.mq.edu.au:8080/vital/access/manager/Repository/mq:7702

Photo Credit: Jonrawlinson /Flickr

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