HIV treatment as prevention: the utility and limitations of ecological observation.

Abstract:

:Results from several observational studies of HIV-discordant couples and a randomized controlled trial (HIV Prevention Trials Network 052) show that antiretroviral therapy (ART) can greatly reduce heterosexual HIV transmission in stable HIV-discordant couples. However, such data do not prove that ART will reduce HIV incidence at the population level. Observational investigations using ecological measures have been used to support the implementation of HIV treatment for the specific purpose of preventing transmission at the population level. Many of these studies note ecological associations between measures of increased ART uptake and decreased HIV transmission. Given the urgency of implementing HIV prevention measures, ecological studies must de facto be used to inform current strategies. However, the hypothesis that widespread ART can eliminate HIV infection may have raised expectations beyond what we may be able to achieve. Here we review and discuss the construct of the exposure and outcome measures and analysis methods used in ecological studies. By examining the strengths and weaknesses of ecological analyses, we aim to aid understanding of the findings from these studies to inform future policy decisions regarding the use of ART for HIV prevention.

journal_name

PLoS Med

journal_title

PLoS medicine

authors

Smith MK,Powers KA,Muessig KE,Miller WC,Cohen MS

doi

10.1371/journal.pmed.1001260

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

e1001260

issue

7

eissn

1549-1277

issn

1549-1676

pii

PMEDICINE-D-11-03006

journal_volume

9

pub_type

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