While the advent of antiretroviral therapy (ART) has increased
survival and reduced the number of acquired immune-deficiency
syndrome (AIDS) related deaths among
people living with the human immunodeficiency virus
(HIV) virus (PLHIV), HIV/AIDS remains a global health
problem and sub-Saharan Africa continues to bear the
greatest burden of disease. There are also major challenges
in the HIV response: as of December 2013, only
36% of PLHIV globally were on ART, and for every individual
started on ART there were two new PLHIV diagnosed.
This has led to considerable debate around adopting
an HIV ‘treat all’ approach aimed at greatly escalating
the number of PLHIV initiated and retained on ART, regardless
of CD4 cell count or World Health Organization
(WHO) clinical stage, with the intended goal of achieving
viral suppression which should in turn reduce HIV transmission,
morbidity and mortality in affected individuals.
This paper examines the issues being discussed in Zimbabwe,
a low-income country with a high burden of HIV/
AIDS, about the implications and opportunities of adopting
an HIV ‘treat all’ approach, along with pertinent operational
research questions that need to be answered to
move the agenda forward. These discussions are timely,
given the recent WHO recommendations advising ART
for all PLHIV, regardless of CD4 cell count.