Abstract
HIV testing and counseling (HTC) is rapidly being brought to scale in sub-Saharan Africa [1]. Scale-up has been driven primarily by the goal of linking HIV-infected persons to treatment. But what impact will HTC scale-up have on HIV prevention, especially as new biomedical HIV prevention interventions are introduced? Consistent with the Couples HIV Testing and Counseling Guidelines recently released by the World Health Organization, we assert that the prevention impact of HTC will hinge on whether both members of HIVdiscordant dyads receive HTC and whether they share their HIV status with each other. However, a better understanding of the prevention impact of other awareness possibilities is needed. We introduce a novel framework for considering a person’s awareness of his/her own HIV status (through HTC) and his/her partner’s HIV status (through HIV disclosure) within HIV-discordant dyads. This framework is useful for understanding HTC trends, examining behavioral and biomedical risk in partnerships, and ultimately optimizing the impact of HIV prevention.
Highlights
Viral hepatitis infection is the leading cause of cirrhosis and primary liver cancer in Africa [1], where hepatitis B surface antigen (HBsAg) prevalence is up to 20% in the general population [2]
In the developed world setting, liver disease has emerged as a leading cause of death in the era of highly active antiretroviral therapy (HAART) [11,12,13] and viral hepatitis co-infection plays an important role in the progression to cirrhosis in hepatitis B and hepatitis C patients, who are co-infected with HIV [14]
Most patients enrolled into the Jos University Teaching Hospital (JUTH)/AIDS Prevention Initiative in Nigeria” (APIN) programme were detected through Voluntary Counselling and Testing (VCT) services in adjacent communities
Summary
Viral hepatitis infection is the leading cause of cirrhosis and primary liver cancer in Africa [1], where HBsAg prevalence is up to 20% in the general population [2]. In the developed world setting, liver disease has emerged as a leading cause of death in the era of HAART [11,12,13] and viral hepatitis co-infection plays an important role in the progression to cirrhosis in hepatitis B and hepatitis C patients, who are co-infected with HIV [14]. This pattern has continued despite increasing availability and administration of HBV-active HAART. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population
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