Comments on: Putting TLC+ to the Test

By: PubH

PubH — Mon, 26 Apr 2010 00:04:52 +0000

Routine testing and specifically access to treatment, are key to curbing the HIV/AIDS epidemic, however this idea assumes that once a patient knows that he or she is HIV+ that he/she will take measures to prevent transmitting it to others. In a perfect world this would be the case. Unfortunately there are many individuals who know their status and continue to engage in unsafe sex (or even “safe” sex) without disclosing their status to sexual partners. I feel this is an aspect of the epidemic that is often overlooked and until this is commonly integrated into prevention campaigns we will continue to see spikes in preventable transmission.

By: Richard Jefferys

Richard Jefferys — Mon, 05 Apr 2010 15:18:52 +0000

“Is it just me or does that sound incredibly paternalistic?”
No, it’s not just you, it’s a poor choice of words at best and at worst it reflects a very limited conception of what the alternatives to financial incentives are. It also only characterizes the downside of delaying treatment from a prevention perspective, when an individual’s health can also suffer profoundly if they lack ongoing access to care. I would argue that educating people about HIV pathogenesis and particularly the potential long term health consequences of persistent immune activation and inflammation should be a critical component of adherence initiatives, on the basis that education could have a more lasting impact than financial incentives (which, as far as I can tell from the literature, typically only have an impact for as long as they are given).

By: Bill Jesdale

Bill Jesdale — Fri, 02 Apr 2010 19:08:22 +0000

“giving them a pat on the back or offering financial incentives”
Is it just me or does that sound incredibly paternalistic?
The NYT recently had an article about how offering people financial incentives for “good” lifestyle choices didn’t work at all.

By: Daniel Reeders

Daniel Reeders — Fri, 02 Apr 2010 04:39:58 +0000

I've just posted a response to this article, with the title "Tender, Loving Financial Incentives", and I hope you won't mind if I post the link here: http://badblood.wordpress.com/2010/04/02/tender-loving-incentives/ I think your program rationale makes sense within the logic of the models you've likely considered, and I talk about different models (behavioural economics, cultures of care) that suggest different directions.

By: Matt Williams

Matt Williams — Tue, 30 Mar 2010 17:50:08 +0000

“If we routinely test everyone for HIV and treat those who are infected, could we bring an end to the HIV/AIDS epidemic?”
The answer is no.
Treatment is by consent. If you reframed this statement to replace having HIV with eating saturated fat would people think you are barmy? Probaly yes, and recommend a softer approach perhaps. Despite cardiovascular disease and type 2 diabetes being an more general health burden, there is not the same moral imperative to treat. It looks like the nicest possible witch hunt.
Furthermore, especially in relation to South Africa, but also the developed world, the model ignores many very real social constraints and valuations around getting an HIV+ diagnosis.
I know personally in South Africa people who tested postitive then died without treatment or commited suicide because the social alternatives were impossible to negotiate. This is hard to get onto modellers’ graphs.
However, if the aim of test and treat+ is to increase access to lifesaving medicine, this is a very good idea. I am interested to see what is proposed regarding overcoming the difficult social valuations which constrain people accessing treatment. And of course, you need to be able to pay for treatment, or get it paid for, which is some countries, including America, is not always possible.
- matt

By: Georgette King

Georgette King — Tue, 30 Mar 2010 09:16:25 +0000

We are very excited about our roll in organizing the TLC-Plus study. More FAQs about TLC-Plus can be found on the HIV Prevention Trials (HPTN) website http://www.hptn.org/web%20documents/HPTN065/065_TLCPlusCmtyFAQv1_25Feb10.pdf . Additional updates will be posted on our Facebook page http://www.facebook.com/USHIVPrev . We welcome your posting of questions and comments on our FB Wall.

By: Shelby

Shelby — Fri, 26 Mar 2010 14:52:01 +0000

TLC is a step in the right direction in decreasing the global impact of HIV/AIDS. It seems like the hardest aspect of the experiment is getting those who test positive to report for treatment.