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Towards test and treat strategy for HIV in sub-Saharan Africa

BMJ 2015; 351 doi: (Published 29 December 2015) Cite this as: BMJ 2015;351:h6839
  1. Sabin Nsanzimana, head 12,
  2. Steve Kanters, director3,
  3. Edward Mills, director3
  1. 1HIV, STI, and Other Blood Borne Infections Division, Rwanda Biomedical Centre, Ministry of Health, Rwanda
  2. 2University of Basel, Swiss Tropical and Public Health Institute, and Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland
  3. 3Global Evaluative Sciences, Vancouver, Canada
  1. Correspondence to: E Mills emills{at}

Antiretroviral treatment for everyone with HIV will help control the epidemic in Africa

Ending the AIDS epidemic has now become a realistic priority for global health policy makers. The Joint United Nations Programme on HIV/AIDS (UNAIDS) announced that 15 million people are now receiving antiretroviral treatment (ART) and that by 2020, 90% of all people with HIV should know their HIV status, 90% of those diagnosed should have access to antiretroviral treatment, and 90% of people receiving treatment should maintain viral suppression (the 90-90-90 targets).1 CD4 cell thresholds have historically guided initiation of treatment, but results from the HIV Prevention Trials Network 052 Trial,2 the Strategic Timing of Antiretroviral Treatment (START) Study,3 and the TEMPRANO Trial4 provide compelling evidence that the benefits of early initiation outweigh any reasons for delay. This evidence has formed the scientific basis for the 90-90-90 targets.

In October 2015, the World Health Organization (WHO) released new treatment guidelines that advocate starting ART immediately, …

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