Nurturing the continuum of HIV testing, treatment and prevention matrix cascade in reducing HIV transmission

Abstract

Background: Despite the shift in antiretroviral therapy (ARVs) eligibility  cascade from CD4 ≤ 200 to CD4 ≤ 350 to CD4 ≤ 500 mm3, HIV related  morbidity and mortality continue to escalate annually, as do HIV infections. The new paradigm of treatment for all HIV positives individual irrespective of CD4 count may significantly reduce HIV and related illnesses. The author assumes that all HIV infected partners should be eligible for HIV treatment and care, irrespective of CD4 count. A second assumption is that high risk HIV negative partners have free access to continuum of HIV pre-exposure prophylaxis  (PrEP), post exposure prophylaxis (PEP) and other prevention packages.

Methods: A literature review search was used to extract evidence-based ARVs-HIV treatment and prevention interventions among HIV positives and high risk partners respectively. Only articles published in English and indexed in journal nuclei were used for the study. The information was used to nurture understanding of HIV treatment and prevention approaches as well as HIV incidence multiplier effect among HIV serodiscordant partners. The imputed HIV incident reference was assumed at 1.2 per 100 person-years (2). This was based on the imputation that retention in care, adherence and other predetermined factors are functions of an effective health care delivery system.

Result: The model showed a reduced HIV transmission from 1.2 per 100  person-years to 1.032 per 100 person-years in 6 months. The average threshold period of HIV suppressed partners on ARVs to an undetectable level. The  combined multiplier protective-effect probability of transmitting HIV from HIV positive partners on ARVs-suppressed viremic load to HIV negative partners on PrEP/PEP-prevention was detected at 86%

Conclusion: The model showed a significant reduction in HIV incidence. Placing serodiscordant sexual partners in HIV treatment and prevention plays a significant role in reducing and controlling HIV infection. Therefore, the policy of enrolling all HIV positives irrespective of CD4 count on ARVs and high risk partners on prevention if adopted and sustained may underpin reduction and control of HIV genotype and HIV related morbidity, mortality and opportunistic infections.

Keywords: HIV, test and treat, linkage to care, prevention, incidence