Universal "Test and Treat" for All HIV+ People In Ethiopia Is Feasible

Background:  From a human rights perspective, all HIV patients, regardless of where they live, and whether or not they are pregnant, should receive ART, the gold standard of care. However, due to costs medication availability, resource-poor countries might not be able to afford this strategy.
Methods: We examined the feasibility of 'test and treat' in Ethiopia, with an estimated overall HIV prevalence of 1.5% (1.9% for women, 1.0% for men). Using current data on the volume of HIV patients, the distribution of CD4 counts, and the price of ARVs and CD4 testing, we calculated the increase in resources required if Ethiopia moves to treat all HIV+ people regardless of CD4 count.
Results: Switching to 'test and treat' regardless of CD4 count will increase ART patients  by 29% and decrease CD4 testing. The current policy for ARVs only at a CD4 count of 500 costs $100,667,400. If CD4 testing is not required to start patients on ART, the total annual cost of a universal treatment policy of al HIV+s would be $113,890,200. Adopting "test and treat" will result in an extra cost of $13,222,800 per year, i.e. a 13% increase. This additional cost is not excessive, considering that 'test and treat' would extend the life of current HIV patients and prevent many new infections, thus reducing future health care costs as fewer patients will be infected.
Conclusions: Implementing 'test and treat' is clearly the most ethical and economically feasible approach and is a reasonable next step for resource poor countries like Ethiopia. There is no reason why Africa should lag behind.