J Public Health Policy. 2012 Aug;33(3):337-43. doi: 10.1057/jphp.2012.21.
Three decades into the HIV/AIDS epidemic, HIV prevention programs have been only partially effective. New prevention tools are providing new reasons for optimism. Effective use of these new tools, including the 'test-and-treat' strategy, will require considerable effort to assure that their potential for prevention is fully realized. Challenges with the test-and-treat strategy are global ones, and include retention in care and adherence to treatment. Worldwide, those with HIV infection become less adherent to antiretroviral therapy over time. Many factors contributing to retention in care and adherence to therapy differ among countries and regions of the world. HIV-infected persons receiving treatment in sub-Saharan Africa have been reported to have higher adherence rates than those receiving treatment on the North American continent; higher health literacy and perception of treatment as a social obligation may enhance adherence to treatment and retention in care. The HIV test-and-treat strategy offers a major step forward when combined with other prevention efforts; we need to consider what additional steps are needed to deliver on the promise of prevention through treatment.
在艾滋病流行的三十年后，艾滋病毒预防规划的效果仅部分有效。新的预防工具为人们带来了新的乐观理由。有效利用这些新工具，包括“检测和治疗”策略，需要付出相当大的努力，以确保充分实现其预防潜力。检测和治疗策略面临着全球性的挑战，包括坚持治疗和坚持护理。全世界范围内，随着时间的推移，艾滋病毒感染者对抗逆转录病毒疗法的依从性会逐渐降低。在世界各地，许多导致坚持护理和治疗的因素因国家和地区而异。据报道，在撒哈拉以南非洲接受治疗的艾滋病毒感染者的治疗依从率高于在北美接受治疗的感染者；较高的健康素养和将治疗视为社会义务的观念可能会增强对治疗的依从性和坚持护理。“检测和治疗”策略是向前迈出的重要一步，如果与其他预防措施相结合，效果会更好；我们需要考虑还需要采取哪些额外的措施来实现通过治疗预防艾滋病的目标。
