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 ≤ 500mm 3 , HIV related morbidity and mortality continue to escalateannually, as do HIV infections. The new paradigm of treatment forall HIV positives individualirrespective of CD4 count maysignificantly reduce HIV and related illnesses. The author assumesthat all HIV infected partners should be eligible for HIV treatmentand care, irrespective of CD4 count. A second assumption is thathigh risk HIV negative partners have free access to continuum ofHIV pre-exposure prophylaxis (PrEP), post exposure prophylaxis(PEP) and other prevention packages.METHODS: A literature review search was used to extractevidence-based ARVs-HIV treatment and prevention interventionsamong HIV positives and high risk partners respectively. Onlyarticles published in English and indexed in journal nuclei wereused for the study. The information was used to nurtureunderstanding of HIV treatment and prevention approaches aswell as HIV incidence multiplier effect among HIV serodiscordantpartners. The imputed HIV incident reference was assumed at 1.2per 100 person-years (2). This was based on the imputation thatretention in care, adherence and other predetermined factors arefunctions of an effective health care delivery system.RESULT: The model showed a reduced HIV transmission from 1.2per 100 person-years to 1.032 per 100 person-years in 6 months.The average threshold period of HIV suppressed partners on ARVsto an undetectable level. The combined multiplier protective-effectprobability of transmitting HIV from HIV positive partners onARVs-suppressed viremic load to HIV negative partners onPrEP/PEP-prevention was detected at 86%CONCLUSION: The model showed a significant reduction in HIVincidence. Placing serodiscordant sexual partners in HIVtreatment and prevention plays a significant role in reducing andcontrolling HIV infection. Therefore, the policy of enrolling allHIV positives irrespective of CD4 count on ARVs and high riskpartners on prevention if adopted and sustained may underpinreduction and control of HIV genotype and HIV related morbidity,mortality and opportunistic infections.