HIV-1 Epidemic Control — Insights from Test-and-Treat Trials

Debate ensued when mathematical models1 predicted that universal testing and treatment could achieve epidemic control within a few years in a high-burden setting. However, the idea rapidly gained new credence when antiretroviral therapy (ART)–induced viral suppression was shown to be highly effective in preventing transmission of human immunodeficiency virus type 1 (HIV-1) in a clinical trial.2 Four large, cluster-randomized, controlled trials, each with a different approach to maximizing viral suppression, set out to assess the effect of universal testing and treatment on community HIV incidence. In 2018, the Treatment as Prevention (TasP) trial3 involving 28,419 persons in 22 communities showed . . .