- The study analysed data from 37 European and Central Asian countries and supports the adoption of test-and-treat antiretroviral therapy (ART) programmes.
- Rapid ART initiation is associated with substantial improvements in population-level access to treatment and viral suppression, compared with ART initiation at CD4 counts ≤350 cells/µL.
- With ART initiation at CD4 counts ≤500 cells/µL there are similar degrees of viral suppression as test-and-treat, but not of ART coverage.
The benefits of test-and-treat programmes for HIV, recommended by the World Health Organization and the European AIDS Clinical Society in 2015 as a means to reduce HIV-related illness, deaths and transmissibility, are demonstrated at the individual level. However, the impact of the initiation of ART immediately upon diagnosis at the population level remains uncertain.
Analysis of data on the prevalence of HIV-positive status, ART guidelines, ART coverage and viral suppression from 37 European and Central Asian countries shows that a test-and-treat program is associated with substantial improvements in population-level access to ART and viral suppression, even after adjusting for potential confounding factors.
Indeed, countries that had test-and-treat policies had a 15.2% (P=0.039) increase of people on ART compared with countries with guidelines recommending treatment initiation at CD4 counts ≤350 cells/µL. Further, test-and-treat was associated with 15.8% (P=0.023) increase of people on ART with viral suppression.
Greater viral suppression was also achieved with ART initiation at CD4 counts ≤500 cells/µL (15.1%; P=0.023) compared with most restrictive ART initiation policy, but there were no statistically significant differences with regard to ART coverage.
Taken together, results indicate that test-and-treat is an effective means to reduce the burden of disease attributable to HIV and to achieve the UNAIDS 90-90-90 target for 2020.
Limitations: risk of ecological fallacy; uncertainty on the implementation of the guidelines, as data are drawn from different years and collected through different procedures; small sample size.