Re: Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission

[Guest guest]

Dear Forum Members,

Re: /message/10267

Universal Voluntary HIV testing is impractical in most of the third world

countries owing to issues of lack of awareness, low information accessibility,

almost non-existent treatment preparedness and high levels of stigma and

discrimination faced by PLHIVs.

Countries like ours (India) still face the stiff task of treatment adherence as

a major obstacle in the ARV rollout leading to drug resistant strains of the

virus. As a mathematical model what is propounded by the Researchers is simple

to understand - the reduction in viral load if ART is initiated immediately upon

knowing sero positive status of an individual lends to negligible or no

transmission of the virus. But implementing it is fraught with dangers of

releasing a drug resistant strain in the general population – leading to

higher mortality rates on the one hand and a heavier burden on the cost of

treatment, care & support. We must be aware of the high costs of second line

drugs.

 

I personally opine that this may not be the correct time to initiate this model.

We are still at the phase where we need to advocate strongly treatment

preparedness among PLHIVs with special stress on treatment adherence.

It would also be in context to state that we have not yet covered all PLHIVs

whose CD4 is under 200 with our present ARV rollout, hence encouraging people to

test so that they can be started on ART seems not only improbable but also

impractical.

The sole purpose of early detection should continue for the time being, to be

for people to change their lifestyles for prolonging life span before ART is

necessitated.

 

While continuing current prevention strategies is a welcome step, provision of

ART irrespective of the CD4 count coupled with the knowledge that viral load

will reduce significantly could very well provide a false sense of security and

compromise the condom program of the country.

 

WHO and the National Programmes in different countries need to consider the flip

side of this mathematical model before venturing on to a policy that may prove

more expensive in the long run both in terms of mortality rates and treatment

costs.

Maybe we just aren't ready for this yet, whatever its efficacy on paper or in

The Lancet.

Sincerely

Sreeram

Sreeram Varadadesikan

e-mail: <setlurs01@...>

[Guest guest]

Dear Friends,

Re: /message/10267

While I totally agree with you on the existing limitations this approach in

present day situation in developing country settings with poor awareness, high

stigma and low uptake of services; this may be a forrunner to change for the

better.

*Ten years ago, before advent of ART, we never reccommended testing, as test or

no test the outcome is behaviour change, so test did not change algorithm al

all, but this changed with advent of ART- if postive go for ART also*.

This one (and another one on increase in life span to near normal -benefit of

early initation of ART) inspire us to think beyond. If we are able to have

policy change to offer ART at early stage, then this may be an incentive to

testign and knowing one's status too, in addition to the benefit of possible

reduction of transmission.

*This does not in any way give a false sense of security- to not use

condoms, as nobody likes to take lifelong medicnes.. even hyperstensives,*

Let's be optimistic to possibilites opened up by new research..

May be I can take some intiatives to pilot it out...and give new hope to PLHIV.

Rajesh.

Dr RK Sood

drrksood@...

+91 9418064077, +91 9445157327

[Guest guest]

Dear FORUM,

I totally agree with Sreeram's points on this.

Firstly I do not think you can call universal testing 'vloluntary'.

I work in Papua New Guinea and their situation for treatment is similar to

India's, they are doing well in getting a reasonal coverage of people who

need need to be on treatment - but still have a long way to go.  They also have

problems of adherance and do not have second line treatment available.

The issue of mathematical modelling is that is does not take into account that

we are dealing with people - not machine.

 

Cheryl

HIV and AIDS Adviser

PNG Law and Justice Partnership

E-MAIL: ckelly77@...

[Guest guest]

Dear FORUM,

Re: /message/10276

The strategy is called out-out testing, and is volunatry as one still has a

right to refuse the test.

I am advocating with the Human rights law network in India to take up the issue

that while upsacling the right to acess to HIV

C & T; no test is to be carried out without the three C- consent

confidentiality and counselling.

Near universal testing also removes the stigma associated with the test, as is

in present day, and may improve access to treatment (first line). We dont

utilise what opportunities we have and pine for others. The coverage on and

PPTMTCT and ART in India in far from satisfactory presently; only when is

normalised more people can come forward to get tested. Testing is also an

opportunity for acceptance of risk and step towards changing risk behaviours,

getting condoms and counselling support.

When we aim at universal coverage, we will actually achieve at soemwhwere near

half way mark, and know better about the status of the disease, as well as

increase access to testing, definitely not at cost of human rights, but as a a

matter of right to access to Testing.

I have found treatment adherence to be good as people have a difficult

access, high tolearbility in our setting, and the PLHIV value it as a

sanjeevani.

RK Sood

Rajesh Sood

e-mail: <drrksood@...>