Simplified HIV Test and Treat program associated with better coverage and lower mortality

A "Test and Treat" protocol for HIV/AIDS diagnosis and treatment, implemented in two Guangxi, China counties in 2012, was associated with increased engagement in HIV/AIDS care and a 62% reduction in mortality among participants, according to a study published this week in PLOS Medicine. This before-and-after analysis, conducted by Zunyou Wu from the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention in Beijing, and colleagues, suggests that broader implementation of the program may inexpensively improve outcomes for HIV-positive individuals in China.

In many countries including China, barriers to diagnosis, linkage to care, and continuation of care still limit effective HIV/AIDS treatment. Wu and colleagues investigated outcomes associated with a simplified "Test and Treat" intervention incorporating same-visit HIV confirmatory testing, pre-ART CD4 baseline testing, pretreatment counseling, and ART eligibility regardless of CD4 count. A total of 1,034 HIV-positive participants were enrolled, 620 before and 414 after program implementation. Following implementation, the number of people receiving CD4 testing within 30 days of HIV confirmation rose from 64% to 97%, and time to ART initiation decreased from around 50 days to 5 days. The proportion of eligible individuals who initiated ART increased from below 52% to above 91%, and mortality rates among eligible participants fell from about 37% to about 13% (all p < 0.001). Wu and colleagues estimated that the cost of each death prevented by the program was about US$235, mostly incurred during the initial year of the intervention.

The pre-post study design, rather than a controlled trial, may limit the accuracy of these findings; in addition, outcomes may not generalize outside China. Nevertheless, these results suggest that a purely structural change can ensure that fewer patients are lost along the continuum of HIV testing and treatment. The authors state, "Our findings provide program-based evidence to support widespread implementation of this intervention in China and to support similar test and treat strategies elsewhere."