New U.S. HIV-Prevention Program to Target Those Already Infected [McCarthy M. Lancet 2001;357:613]: This is a brief report in Lancet concerning the announcement of a "major shift in strategy," in an attempt to reduce the incidence of HIV infection by 50% (from 40,000 to 20,000 infections per year) over the next five years. The new strategy is the "Serostatus Approach to Fighting the HIV Epidemic" (SAFE) to be run by the CDC. The previous focus was on educating persons at high-risk. The new program will deal with those who are already infected and will include an attempt to identify the estimated one-third of patients who have HIV infection and have not been tested. The hope is that the number of infected patients who are aware of their HIV infection will increase from 70% to 95% by the year 2005, and this will foster transmission reduction through counseling and antiviral therapy to reduce infectivity.
Comment: Many will view this as a long overdue shift in emphasis by the CDC. The policy shift comes at the time the IOM has been highly critical of the U.S. prevention efforts. The IOM identified three areas that needed emphasis: realistic sex education in schools, support for needle exchange as the most cost-effective HIV prevention method, and adequate reimbursement for counseling. It is not yet clear how these strategies will be incorporated in the SAFE program. With regard to case detection, the effort will be notably enhanced with the availability of rapid tests, particularly those that can be provider read, are inexpensive, and use non-blood specimens such as saliva. This technology is currently under review by the FDA.
posted 3/8/2001

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