Test and Start: Optimizing Antiretroviral Therapy Services to Save Lives

Ishmael and Patricia take antiretroviral drugs at their home in Chitungwiza, Zimbabwe.
Ishmael and Patricia take antiretroviral drugs at their home in Chitungwiza, Zimbabwe. They have accepted their HIV-positive status and support each other to adhere to HIV treatment.
Photo credit: Tsvangirayi Mukwazhi/OPHID Trust

In October 2015, the World Health Organization issued guidance on what it calls the treat-all approach—recommending antiretroviral therapy (ART), for everyone living with HIV at any CD4 cell count. Commonly known as Test and Start, this approach begins patients on ART immediately after an HIV-positive diagnosis in an effort to improve health outcomes. Study evidence shows that the earlier patients initiate ART, the better they do.

The U.S. Agency for International Development (USAID) uses the Test and Start approach as a strategy to achieve the UNAIDS 90-90-90 treatment targets. To reach the targets of the second and third 90, USAID’s Office of HIV/AIDS is taking a leading role in innovative service delivery models and in advancing antiretroviral drugs that are more effective and less expensive. These efforts, in combination with USAID’s global health supply chain management, strive to rapidly expand coverage of ART services, save lives, and reduce ongoing transmission of HIV.

Costs are a significant barrier to providing ART to those who need it most. In order to reduce costs and improve impact, USAID works with implementing partners to provide tailored services. This includes customizing the type of service, the delivery methodology, the frequency of service, and the service provider. This customization helps reduce the burden on health facilities while increasing treatment initiation, patient retention, and disease suppression.

Addressing the spectrum of the 90-90-90 goals are two innovative USAID-supported projects: OPTIMIZE and EQUIP. Awarded in 2015, OPTIMIZE and EQUIP seek to revolutionize treatment and service delivery through initiatives led for the first time solely by two African-based partners.

USAID’s innovative partnerships and technical leadership are positioned to expand coverage and drive down costs to facilitate the Test and Start approach – ensuring that people can access lifesaving HIV treatment and care, which is critical to realizing the vision of a world free of the AIDS epidemic.

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