The comparative effectiveness of antiretroviral therapies for HIV: evidence to inform precision public health

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The HIV/AIDS epidemic represents one of the greatest public health challenges of the past century. Since its discovery in 1981, an estimated 35 million people have died and an estimated 37 million people currently live with this viral infection [1,2]. The effects of this pandemic have devastated relationships, households and economies. While the disease disproportionately affects people in low-income settings, particularly Africa, research related to the effectiveness of interventions has predominantly been conducted in low endemic settings, such as the western world [3]. Until the roll-out of antiretroviral therapy (ART) under the direction of the President’s Emergency Plan for AIDS Response (PEPFAR) in 2003, few policy-makes expected to be able to provide lifelong ART to patients in poor settings, including Africa and Asia. However, using a simple public health approach based on treating the sickest patients and the most vulnerable (typically mothers to avoid vertical transmission to babies) first, the expansion of ART in developing settings has had remarkable success and now provides lifelong ART to an estimated 18.2 million patients [4]. These successes were built on a framework that provides simplified therapy using a choice of ART that minimizes adverse events and resistance and is associated with negotiated price reductions according to the payers.

Click here to read the full article in the Journal of Comparative Effectiveness Research.

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