"Despite the test-and-treat strategy's promise, unanswered questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community."
Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV "Test-and-Treat"
In 2011 some 2.5 million people worldwide were newly infected with HIV. One promising strategy to control the spread is called test-and-treat. This strategy calls for routinely testing individuals for HIV and immediately starting those infected on anti-retroviral therapy (ART), regardless of the stage of their disease. This would reduce infected individuals’ plasma viral load and the likelihood of them transmitting the infection.
These researchers conducted a systematic review of the scientific literature to identify clinical, health service, and ethical issues surrounding the test-and-treat strategy.
Published models showing test-and-treat as eliminating HIV were derived from “uncertain or unreal assumptions.”
Concerns were raised that test-and-treat would lead to more risk-taking among HIV-infected individuals and have less effect on preventing HIV transmission.
Test-and-treat depends on timely detection of infection and that is not feasible in high-prevalence settings that also are low on health resources.
Early treatment and life-long ART treatment may lead to drug toxicity and drug resistance.
Poverty, incarceration, substance abuse, and stigma present barriers to ART adherence.