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- W1964096964 abstract "Reuben Granich and colleagues explore a policy of universal voluntary HIV testing with immediate anti retroviral therapy as a strategy for elimination of HIV transmission. I wonder how relevant their findings are given that the models used do not account for concurrency-i.e. overlapping longterm partnerships-which are likely to account for a substantial amount of HIV transmission in South Africa. Granich and colleagues do state that their model allows for a high level of concurrency and for a much higher infectiousness during the phase than during the chronic phase. However the reference they use to support this statement does not model concurrency but uses a basic risk-category deterministic model combined with a factor for changes in viral load. This is not the same thing as modelling concurrency which is a network effect enhanced by but independent of viral load fluctuations. For deterministic models to approximate the observed prevalence of HIV they must make unreasonable assumptions about African sexual behaviour. The authors of the cited paper and presumably Granich and colleagues assume that 1% of people have on average 77 partners per year. Behavioural surveys from Africa have never found such high levels of promiscuity. The authors assumption is derived not from behavioural data but from the demands of the model itself. The model would not predict actual prevalence otherwise. Network models do not require unrealistic assumptions and are much better able to derive prevalence estimates on the basis of actual behavioural data. Thus it would seem worth modelling the effect of testing and antiretroviral therapy with a network model that includes concurrent partnerships. At the very least factoring in concurrency would increase the relative amount of transmission attributable to the acute phase-i.e. when infection is not even detectable on an HIV test- beyond that calculated by Abu-Raddad and Longini (and presumably Granich and colleagues). That would reduce the effect of testing and early treatment significantly I suspect. (full-text)" @default.
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- W1964096964 date "2009-03-01" @default.
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- W1964096964 title "Universal voluntary HIV testing and immediate antiretroviral therapy – Authors' reply" @default.
- W1964096964 doi "https://doi.org/10.1016/s0140-6736(09)60648-6" @default.
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