If we routinely test everyone for HIV and treat those who are infected, could we bring an end to the HIV/AIDS epidemic? The test and treat concept, modeled on data from South Africa by scientists at the World Health Organization, is a provocative HIV prevention strategy. According to mathematical modeling, a successfully implemented test and treat program could significantly reduce the number of HIV infections in South Africa within 10 years. While a growing number of experts within the HIV/AIDS community are intrigued at the possibility, no one knows whether this strategy would work in the real world.
The National Institutes of Health (NIH), the premier research institution of the U.S. government, is taking steps to find out. NIH is planning a 3-year study in 6 major U.S. cities. Called TLC+ (for Enhanced Test, Link to Care Plus Treat Strategy), this study will explore the feasibility of expanding HIV testing, better linking those who test HIV positive to medical care and treatment, and improving adherence to HIV treatment. The components of TLC+ will be evaluated against the current standard of HIV testing and treatment.
Its effectiveness will depend on a number of key factors. For starters, TLC+ requires a high level of acceptance and commitment to routine HIV testing. Changing public perception is never easy, so we’ll need various forms of social marketing to help lay the groundwork for a more supportive environment. The success of TLC+ also hinges on the ability to reach at-risk individuals. Outreach will be critical, so expanding HIV testing services at strategic sites such as emergency rooms and hospital admission desks is a good place to start.
The next critical component of TLC+ is successfully linking newly diagnosed individuals into care and treatment. Unfortunately, many people don’t make it to their follow-up medical visits for a variety of reasons. Yet these individuals can continue to spread the virus in their communities until we entice them to step through the door, whether it’s giving them a pat on the back or offering financial incentives.
Finally, all HIV-infected individuals, regardless of disease stage, need to start antiretroviral therapy (ART) when they and their health care provider decide it’s the right time. Equally as important as starting, they need to faithfully adhere to their drug regimens to ensure good health, low risk of HIV-related complications and reduce the risk of developing drug resistance. We know that ART can dramatically lower the level of the virus in the blood to undetectable levels, which may reduce the risk of HIV transmission. This is a crucial step in the TLC+ strategy that will hopefully pay future dividends in reducing the spread of HIV in communities.