Wafaa El-Sadr presented a comprehensive over view of treatment as prevention strategies and studies. the data came from both African and US studies. Importantly she indicated that all aspects of a program were important, increasing test, increasing engagement with care, lowering the CD4 count at which treatment is initiated and treatment ahderance. She estimated that of the approximate 1,200,000 Americans living with HIV approximately 850,000 were not successfully on treatment. This theme is maintained in the posters, where an interesting poster from New Jersey #1075 by Ruthie Birger provides a hierarchy of interventions necessary to impact community transmission.
Wafer's talk is now available from the CROI website and it is well worth a viewing, particularly for anyone thinking about test and treat. It was very suprising for me to really get a handle on just how poor coverage of treatment is in parts of the USA, given there is so much research which comes from here.