Clinical uncertainties, health service challenges, and ethical complexities of HIV "test-and-treat": a systematic review

Am J Public Health. 2013 Jun;103(6):e14-23. doi: 10.2105/AJPH.2013.301273. Epub 2013 Apr 18.


Despite the HIV "test-and-treat" strategy's promise, questions about its clinical rationale, operational feasibility, and ethical appropriateness have led to vigorous debate in the global HIV community. We performed a systematic review of the literature published between January 2009 and May 2012 using PubMed, SCOPUS, Global Health, Web of Science, BIOSIS, Cochrane CENTRAL, EBSCO Africa-Wide Information, and EBSCO CINAHL Plus databases to summarize clinical uncertainties, health service challenges, and ethical complexities that may affect the test-and-treat strategy's success. A thoughtful approach to research and implementation to address clinical and health service questions and meaningful community engagement regarding ethical complexities may bring us closer to safe, feasible, and effective test-and-treat implementation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy*
  • HIV Infections / prevention & control
  • HIV*
  • Health Promotion / ethics
  • Health Promotion / methods*
  • Humans
  • Program Evaluation
  • Uncertainty