Relevance to Test-and-Treat Strategies for Prevention of HIV Infection

(See the editorial commentary by Lange, on pages 801–802.) For individuals with human immunodeficiency virus (HIV) infection to fully benefit from potent combination antiretroviral therapy, they need to know that they are HIV infected, be engaged in regular HIV care, and receive and adhere to effective antiretroviral therapy. Test-and-treat strategies for HIV prevention posit that expanded testing and earlier treatment of HIV infection could markedly decrease ongoing HIV transmission, stemming the HIV epidemic. However, poor engagement in care for HIV-infected individuals will substantially limit the effectiveness of test-and-treat strategies. We review the spectrum of engagement in care for HIV-infected individuals in the United States and apply this information to help understand the magnitude of the challenges that poor engagement in care will pose to test-and-treat strategies for HIV prevention. Over the past decade, antiretroviral therapy has become more potent, better tolerated, and less complex. Today, most human immunodeficiency virus (HIV)–infected individuals receiving combination antiretroviral therapy achieve an undetectable plasma HIV- RNA level [1, 2]. Nevertheless, deficits in the spectrum of engagemen