Specialists at the World Health Organisation have claimed that “universal and annual voluntary testing followed by immediate antiretroviral therapy treatment” could reduce new HIV cases by 95% within 10 years.

That is the conclusion of a mathematical model developed by a group of HIV specialists at WHO. The findings have just been published in The Lancet and the authors say that universal voluntary testing followed by immediate ART would reduce the incidence of tuberculosis and the transmission of HIV from mother to child.

The report is based on a computer model of data from South Africa to assess the effect of annually testing everyone aged 15 and over for HIV and starting them on ART immediately after they are diagnosed. Such a strategy could reduce HIV incidence and mortality to less than one case per 1,000 people within 10 years, and cut the number of AIDS deaths by 50% between now and 2050.

The authors note that within a few years, the annual cost of the strategy would total $3.4 billion in South Africa, which is almost three times the expected cost of treatment under current WHO guidelines. They stress however, “the theoretical nature of the exercise” and raise a number of concerns regarding feasibility, including the protection of “individual rights, drug resistance, toxicity and financing challenges”.

In an accompanying article in The Lancet, Geoffrey Garnett from Imperial College London, UK, wrote that at its best, the strategy suggested by the WHO researchers “would prevent morbidity and mortality for the population, both through better treatment of the individual and reduced spread of HIV. At its worst, the strategy will involve over-testing, over-treatment, side effects, resistance and potentially reduced autonomy of the individual in their choices of care."

Dr Garnett concluded by saying that “it is easy to see how enforced testing and treatment for the good of society would follow from such an argument”. However these fears are not shared by the AIDS Healthcare Foundation.

Michael Weinstein, president of the AHF, the USA’s largest and oldest AIDS support organisation, said that “with this study, another nail has been pulled from the coffin of those in need of testing and treatment and those who would most benefit from the immediate massive scale up of HIV testing and lifesaving treatment around the globe”. He added that the report “supports AHF’s position that global HIV testing efforts remain woefully under-funded” and “we are calling on global funding bodies…to take immediate action and change the course of their respective global efforts”.