Can we stop AIDS with antiretroviral-based treatment as prevention?

Edward J Mills, Jean B Nachega, Nathan Ford, Edward J Mills, Jean B Nachega, Nathan Ford

Abstract

Challenges to scaling up treatment as prevention (TasP) of HIV transmission are considerable in the developing-world context and include accessing at-risk populations, human resource shortages, adherence and retention in care, access to newer treatments, measurement of treatment effects, and long-term sustainable funding. Optimism about ending AIDS needs to be tempered by the realities of the logistic challenges of strengthening health systems in countries most affected and by balancing TasP with overall combination prevention approaches.

Conflict of interest statement

Competing Interests: Edward Mills has received research funding to evaluate treatment as prevention from the Canadian Institutes of Health Research. Edward Mills and Nathan Ford have been advisors to Médecins Sans Frontières on a research project evaluating treatment as prevention.

Figures

FIGURE.
FIGURE.
The Leaky HIV Treatment Cascade The cascade of HIV care proceeds from testing and clinical staging to ART eligibility, receipt of ART, and successful, uninterrupted treatment. Each step opens the possibility to losing patients to follow-up, which has been documented by a number of studies. Abbreviations: ART, antiretroviral therapy; LTF, loss to follow-up.

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