Is ART for Treatment and Prevention a Win–Win?

Several years ago, Reuben Granich and colleagues published a landmark paper in the Lancet, projecting the effects that a provocative “test-and-treat” approach could have on the HIV epidemic in sub-Saharan Africa (JW AIDS Clin Care Dec 15 2008). Now, these researchers have enhanced their analysis, with a focus on net health-system costs and the cost-effectiveness of widely expanded access to antiretroviral therapy (ART).

Granich and colleagues used a mathematical model to examine four possible thresholds for ART eligibility — CD4 count <200 cells/mm³, CD4 count <350 cells/mm³, CD4 count <500 cells/mm³, and “ART for all” (any CD4-cell count) — in an ideally functioning program (i.e., 90% annual testing, optimal linkage to care, and 1.5% annual…