Simplified HIV Test and Treat program associated with better coverage and lower mortality

In many countries including China, barriers to diagnosis, linkage to care, and continuation of care still limit effective HIV/AIDS treatment. Wu and colleagues investigated outcomes associated with a simplified "Test and Treat" intervention incorporating same-visit HIV confirmatory testing, pre-ART CD4 baseline testing, pretreatment counseling, and ART eligibility regardless of CD4 count. A total of 1,034 HIV-positive participants were enrolled, 620 before and 414 after program implementation. Following implementation, the number of people receiving CD4 testing within 30 days of HIV confirmation rose from 64% to 97%, and time to ART initiation decreased from around 50 days to 5 days. The proportion of eligible individuals who initiated ART increased from below 52% to above 91%, and mortality rates among eligible participants fell from about 37% to about 13% (all p < 0.001). Wu and colleagues estimated that the cost of each death prevented by the program was about US$235, mostly incurred during the initial year of the intervention.

The pre-post study design, rather than a controlled trial, may limit the accuracy of these findings; in addition, outcomes may not generalize outside China. Nevertheless, these results suggest that a purely structural change can ensure that fewer patients are lost along the continuum of HIV testing and treatment. The authors state, "Our findings provide program-based evidence to support widespread implementation of this intervention in China and to support similar test and treat strategies elsewhere."