Effectiveness and Cost-Effectiveness of Treatment as Prevention for HIV

Authors: Charles Holmes, Timothy Hallett, Rochelle Walensky, Till Bärnighausen, Yogan Pillay, Myron Cohen


The beneficial effects of antiretroviral therapy (ART) as treatment for HIV focus on four lines of evidence: (1) observational studies of serodiscordant couples, (2) HPTN 052 randomized controlled trial, (3) ecological studies, and (4) population-based studies. Given the effectiveness of treatment for reducing the sexual transmission of HIV, it is increasingly important for policy makers to consider the cost-effectiveness of interventions. Modeling cost-effectiveness also requires examining initiation of treatment earlier in the course of disease than has occurred in most LMICs. Policymakers need to consider questions of trade-offs of expanding testing vs, expanding earlier treatment and what approaches could improve the cost-effectiveness of treatment as prevention. Ongoing research is evaluating the biological, pharmacologic, clinical, and public health elements of ART as a prevention modality.