1. The Impact of the 2013 WHO Antiretroviral Therapy Guidelines on the Feasibility of HIV Population Prevention Trials
- Author
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Callie A. Scott, François Dabis, Elena Losina, Eric L. Ross, Rodolphe Thiébaut, Kenneth A. Freedberg, Milton C. Weinstein, Pamela Pei, Frank Tanser, Marie-Louise Newell, Rochelle P. Walensky, Xavier Anglaret, Massachusetts General Hospital [Boston], Africa Centre for Health and Population Studies, University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN)-Medical Research Council of South Africa, Faculty of Social, Human and Mathematical Sciences [Southampton], University of Southampton, Department of Orthopedic Surgery [Boston], Brigham and Women's Hospital [Boston], Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Statistics In System biology and Translational Medicine (SISTM), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Department of Applied Physics and Applied Mathematics [New York] (APAM), Columbia University [New York], Harvard Medical School [Boston] (HMS), Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Department of Infectious Disease [Boston], Center for AIDS Research [Cambridge], Harvard University, University of KwaZulu-Natal (UKZN)-Medical Research Council of South Africa, and Harvard University [Cambridge]
- Subjects
medicine.medical_specialty ,Time Factors ,Anti-HIV Agents ,[SDV]Life Sciences [q-bio] ,Population ,Alternative medicine ,Human immunodeficiency virus (HIV) ,HIV Infections ,World Health Organization ,medicine.disease_cause ,Models, Biological ,Sensitivity and Specificity ,Article ,World health ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,Computer Simulation ,Pharmacology (medical) ,030212 general & internal medicine ,Intensive care medicine ,education ,Clinical Trials as Topic ,0303 health sciences ,education.field_of_study ,030306 microbiology ,business.industry ,Incidence ,Incidence (epidemiology) ,Antiretroviral therapy ,CD4 Lymphocyte Count ,3. Good health ,Infectious Diseases ,Physical therapy ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Prevention trials ,business - Abstract
BACKGROUND: Several cluster-randomized HIV prevention trials aim to demonstrate the population-level preventive impact of antiretroviral therapy (ART). 2013 World Health Organization (WHO) guidelines raising the ART initiation threshold to CD4 METHODS: We used a computational model to simulate strategies from a hypothetical cluster-randomized HIV prevention trial. The primary model outcome was the relative reduction in 24-month HIV incidence between control (ART offered with CD4 below threshold) and intervention (ART offered to all) strategies. We assessed this incidence reduction using the revised (CD4 RESULTS: With a control ART initiation threshold of CD4 CONCLUSIONS: Implementing the 2013 WHO HIV treatment threshold could substantially diminish the incidence reduction in HIV population prevention trials. Alternative HIV testing frequencies and trial horizons can bolster this incidence reduction, but they could be logistically and ethically challenging. The feasibility of HIV population prevention trials should be reassessed as the implementation of treatment guidelines evolves.
- Published
- 2014
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