The best strategy to defeat HIV in South Africa—study challenges WHO's approach

September 5, 2012

The World Health Organization is about to roll out a new strategy for AIDS prevention in South Africa, a country where more than 5 million people are infected with HIV. Based on a mathematical model, the WHO predicts this strategy will completely eliminate HIV in South Africa within a decade.

But not so fast, suggests a group of UCLA researchers. Their work challenges the proposed strategy by showing it could lead to several million individuals developing drug- of . And further, they say, it will cost billions of dollars more than the WHO has estimated.

Reporting in the current issue of the journal , senior author Sally Blower, director of the UCLA Center for Biomedical Modeling, and first author Bradley Wagner, a postdoctoral scholar in Blower's lab, used sophisticated computer modeling to evaluate the WHO's proposed strategy.

"By developing our own and reevaluating the WHO's proposed strategy for South Africa, we found the WHO's predictions are wrong," Blower said.

"This is because their is unrealistic," Wagner added. "If you use an unrealistic model, you get the wrong answer."

The method under debate is the WHO's universal "test and treat" strategy. This strategy is based on testing the entire population of South Africa annually for HIV, then treating every individual immediately after infection, before they develop symptoms. "Test and treat" uses as a method of prevention, as treatment makes individuals less infectious. It would mean treating nearly 5 million individuals in South Africa almost immediately, the UCLA researchers say.

The WHO model predicts "test and treat" would be better than only treating the 1.6 million people in South Africa who have symptoms and actually need treatment. The organization's model predicts that treating the 1.6 million alone would not eliminate HIV and, over 40 years, such an approach would be more expensive than the "test and treat" strategy.

"But," Blower said, "our model shows the opposite."

"Our model shows that providing treatment to the 1.6 million people who are in need of treatment would be very effective as a form of 'treatment as prevention,'" said Wagner. "It could bring the HIV epidemic in South Africa close to elimination and prevent 11 million infections over the next 40 years. Our model also shows the WHO's 'test and treat' strategy would actually cost $12 billion more than providing treatment to the 1.6 million in need."

"The difference between our results and those of the WHO is because we assume that drug-resistant strains can develop in treated individuals, and therefore they will need more expensive 'second-line' drugs," Blower said. "The WHO assumes drug resistance will not evolve, and, essentially, there will be no need for 'second-line' drugs."

The UCLA researchers said they agree that the WHO's "test and treat" strategy would indeed prevent many infections. But realistically, that strategy would require substantial financial resources and a robust health infrastructure. Unfortunately, they say, such resources are not available.

"Before implementing a 'test and treat' strategy, we recommend trying to provide treatment for all those in need as quickly as possible," said Wagner. "This is desperately needed in South Africa."

Blower added, "If we could provide treatment to the 1.6 million people in need, it would increase their life expectancy by several decades and also save millions of lives. And this is a strategy that can be implemented immediately."

Explore further: Researchers suggest unconventional approach to control HIV epidemics

Related Stories

Researchers suggest unconventional approach to control HIV epidemics

December 7, 2011
(Medical Xpress) -- A new weapon has emerged to prevent HIV infection. Called pre-exposure prophylaxis, or PrEP, it is a strategy of providing medications to at-risk people before they are exposed to the virus. Having shown ...

Expanding HIV treatment for couples could significantly reduce global HIV epidemic

October 18, 2011
A new study uses a mathematical model to predict the potential impact of expanding treatment to discordant couples on controlling the global HIV epidemic-- in these couples one partner has HIV infection and the other does ...

Hope for more options in couples where one partner is HIV positive

November 15, 2011
In sub-Saharan Africa, couples in long-term relationships where one partner is HIV-positive and the other is HIV-negative (HIV serodiscordant couples) could benefit from anti-AIDS drugs (antiretroviral therapy) given either ...

Recommended for you

Scientists divulge latest in HIV prevention

July 25, 2017
A far cry from the 1990s "ABC" campaign promoting abstinence and monogamy as HIV protection, scientists reported on new approaches Tuesday allowing people to have all the safe sex they want.

Girl's HIV infection seems under control without AIDS drugs

July 24, 2017
A South African girl born with the AIDS virus has kept her infection suppressed for more than eight years after stopping anti-HIV medicines—more evidence that early treatment can occasionally cause a long remission that, ...

Meds by monthly injection might revolutionize HIV care (Update)

July 24, 2017
Getting a shot of medication to control HIV every month or two instead of having to take pills every day could transform the way the virus is kept at bay.

Candidate AIDS vaccine passes early test

July 24, 2017
The three-decade-old quest for an AIDS vaccine received a shot of hope Monday when developers announced that a prototype triggered the immune system in an early phase of human trials.

Paris spotlight on latest in AIDS science

July 21, 2017
Some 6,000 HIV experts gather in Paris from Sunday to report advances in AIDS science as fading hopes of finding a cure push research into new fields.

Scientists elicit broadly neutralizing antibodies to HIV in calves

July 20, 2017
Scientists supported by the National Institutes of Health have achieved a significant step forward, eliciting broadly neutralizing antibodies (bNAbs) to HIV by immunizing calves. The findings offer insights for HIV vaccine ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.