Federal pilot study -- increased testing as a tool to stop the epidemic

[Assurbanipal]

From the New York Times

WASHINGTON — Federal health officials are preparing a plan to study a bold new strategy to stop the spread of the AIDS virus: routinely testing virtually every adult in a community, and promptly treating those found to be infected.

The strategy is called “test and treat,” and officials say the two sites for the three-year study will be the District of Columbia and the Bronx — locales with some of the nation’s highest rates of infection with human immunodeficiency virus.

The officials emphasize that this is just a first step. The goal is not to measure whether “test and treat” actually works to slow an epidemic, but whether such a strategy can even be carried out, given the many barriers to being tested and getting medical care.

Complete story http://www.nytimes.com/2009/10/27/health/27hiv.html?em

[skeebo1969]

  Call me a pessimist, but why am I getting visions of carte blanche and the Gestapo?  I think something is really wrong with me I use to be such a patriotic American... guess I'll have to wait for the 20/20 coverage on this one.  I just don't want to see people being dragged into a testing center by a bunch of thug cops.

 

[Ann]

  Call me a pessimist, but why am I getting visions of carte blanche and the Gestapo?  I think something is really wrong with me I use to be such a patriotic American... guess I'll have to wait for the 20/20 coverage on this one.  I just don't want to see people being dragged into a testing center by a bunch of thug cops.

Routine testing has nothing to do with being dragged into testing centers. What it means is that people will be routinely offered testing when they access healthcare for whatever reason. I think it's a good idea. As we tell people in the Am I Infected forum, all sexually active adults (and teens) should be routinely  tested at least once a year, not only for hiv, but for other STIs as well.

And by the way, this "test and treat" idea relates to things like chlamydia too. We had a big debate here in recent weeks about the cost of hiv treatment vs the cost of infertility treatment. How many people are aware that untreated chlamydia infection is one of the leading causes of infertility in women? I don't mean to hijack this thread, but this is just another example of how valuable - and ultimately cost-saving - routine testing for STIs, including hiv, can be.

Hiv testing needs to be made as routine as having a CBC done when seeing the doctor for anything from a general check-up to investigating an illness. It would go a long way towards slowing this pandemic down. It would also go a ways towards getting rid of the stigma.

Ann

[Inchlingblue]

The only problem with this idea is the fact that there is no adequate health care coverage in this country.

If they can back it up by offering everyone, regardless of income or anything else, comprehensive health care, then it's a great idea.

Just look at ADAP, which is not even comprehensive health care, just HIV drugs and lab tests: most state's ADAPs are struggling and people are on waiting lists, with more cuts expected if the number of cases goes up (despite the recent reauthorizations). What is the government going to do when these programs to test everyone uncover many more cases of people with HIV who will need health care and won't have it?

[Assurbanipal]

To be fair, this is a pilot program and there are no ADAP waiting lists in the places where the pilot will be going off. 

And if it is a 3 year pilot, there will be a lot more generic antiretrovirals available to ADAP programs by the time it is ready to ramp out.

[Inchlingblue]

To be fair, this is a pilot program and there are no ADAP waiting lists in the places where the pilot will be going off.  

And if it is a 3 year pilot, there will be a lot more generic antiretrovirals available to ADAP programs by the time it is ready to ramp out.

But the whole point of pilot programs is to see if it's worth doing on a larger scale. All I'm saying is it's all well and good to test everyone but it has to be backed up with the proper support services which, at least for the moment, are sorely lacking.

Which patented meds are set to expire in the next three years (other than Epivir coming up soon)?

[Assurbanipal]

Which patented meds are set to expire in the next three years (other than Epivir coming up soon)?

Started looking that up and so far found:

Emtriva (included in Truvada)
Ziagen (the other half of Epzicom / Kivexa)

And in year 4, Enfurvirtide (Fuzeon)  and maybe Sustiva?

Editied to correct year for Fuzeon and to say I'll put up a list in the generics thread later

[dixieman]

I think it would be great to start testing everyone... the numbers of people infected with STD's not only HIV will shock the general population... the United States has the Highest numbers in the industrialized nations for STD's... this is just one reason for healthcare reform out of many is greatly needed...

[skeebo1969]

  Please, someone clear this up for me then.  My reading comprehension skills are obviously lacking as of late.  So they are going to get "everyone" in the community to test by "offering" routine testing for those that come into medical facilities and  possibly Wal-mart while buying a gal of milk?  With the exception of the innovative Wal-mart concept isn't this what they are doing now?  They say nothing about those who decline, but yet make mention of having "everyone" tested in the community.  How do they get past the hurdle of those who decline testing let alone treatment for those who do test pos?

  

[Assurbanipal]

 Please, someone clear this up for me then.  My reading comprehension skills are obviously lacking as of late.  So they are going to get "everyone" in the community to test by "offering" routine testing for those that come into medical facilities and  possibly Wal-mart while buying a gal of milk?  With the exception of the innovative Wal-mart concept isn't this what they are doing now?  They say nothing about those who decline, but yet make mention of having "everyone" tested in the community.  How do they get past the hurdle of those who decline testing let alone treatment for those who do test pos?

  

I think you are looking for greater definition than exists so far.  This is at the "plan to study a strategy" point.  

There was a little more info on what they were thinking about here:


Researchers planning the study have been meeting with hospital and health officials in Washington and the Bronx to discuss making H.I.V. testing a routine part of visits to doctors, clinics and emergency rooms.

Dr. Fauci said testing might also be widely offered in nonmedical settings. “When you have a campaign like this, you’ve got to pull out all the stops,” he said. “How are we going to get everybody? Should we have testing in Wal-Mart? Should we have testing at Nathan’s hot dog places?”

[Ann]

The only problem with this idea is the fact that there is no adequate health care coverage in this country.

If they can back it up by offering everyone, regardless of income or anything else, comprehensive health care, then it's a great idea.

I can't agree with that. Not knowing one's hiv status is not a case of ignorance is bliss. It's going to progress and and possibly kill a person who doesn't know they're poz whether or not affordable and accessible health care is in place. People who don't know they're hiv positive are still going to be infecting others regardless of whether or not there is adequate health care coverage.

People who know they are hiv positive, by and large, do what they need to do to prevent onward infection, regardless or whether or not they have health insurance or access to health care.

Getting people into the habit of routine testing will be one very big step towards ending this pandemic, through the halt - or at the very least, slowdow - of new infections. We do routine TB testing and to my mind, this is NO different, except perhaps in the frequency.

(Sorry for the late response, my computer went haywire for a few days. It's still in the shop, I'm on a borrowed PC at a mate's house.)

Ann

[Inchlingblue]

The whole point of this pilot program ("test and treat") will in fact be to treat those who are found to be poz. They will be "routinely testing virtually every adult in a community, and promptly treating those found to be infected." If it works at reversing the current trend of rising numbers of HIV infections then presumably they'll take it nationally.

I hope it is a success because it could lead to a more nationwide effort to "test and treat." It's just that when I read about ADAP waiting lists and experience first-hand what a mess the US health care system is in, it makes me question the sincerity of the follow-up treatment to all that testing.
 
The epidemic could very likely be stopped in it's tracks if everyone got tested and received the best treatment available. It could also be stopped in its tracks if everyone not in a strictly monogamous relationship used condoms all the time, no exceptions, but that's not likely to happen.  

Treatment nowadays isn't as scary as it used to be. The scary thing is not having access to it since it's so #!*@!*# expensive.