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Published June 2013 | public
Journal Article

Clinical Uncertainties, Health Service Challenges, and Ethical Complexities of HIV "Test-and-Treat": A Systematic Review

Abstract

Despite the HIV "test-and-treat" strategy's promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy's success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation.

Additional Information

© 2013 American Public Health Association. Accepted on: Feb 1, 2013. This research was supported by the University of California, Los Angeles (UCLA), Robert Wood Johnson Foundation Clinical Scholars Program (to S. P. K.); the National Institutes of Health (NIH), National Institute of General Medical Sciences (grant GM08042 to K. V. S.); the UCLA-Caltech Medical Scientist Training Program (to K. V. S.); the Centers for AIDS Research (grant 5P30 AI028697 to A. P. M.); the UCLA AIDS Institute (to A. P. M.); and the UCLA Clinical and Translational Science Institute (grant 1UL 1RR033 176 to A. P. M.). The authors thank Shilpa Sayana, MD, MPH, for helpful discussion and comments on earlier versions of this article. Contributors: S. P. Kulkarni and A. P. Mahajan were responsible for the conceptualization and design of the study. S. P. Kulkarni led the writing of the article. All authors participated in developing the review protocol, reviewing articles for inclusion criteria, extracting data from the articles, interpreting the data, and revising the article; all approved the final version. Human Participant Protection: No protocol approval was necessary because data were obtained from secondary sources.

Additional details

Created:
August 19, 2023
Modified:
October 26, 2023