Journal of Applied Mathematics

Adding Education to “Test and Treat”: Can We Overcome Drug Resistance?

Mo’tassem Al-arydah and Robert Smith?

Full-text: Access denied (no subscription detected)

We're sorry, but we are unable to provide you with the full text of this article because we are not able to identify you as a subscriber. If you have a personal subscription to this journal, then please login. If you are already logged in, then you may need to update your profile to register your subscription. Read more about accessing full-text


Recent mathematical modelling has advocated for rapid “test-and-treat” programs for HIV in the developing world, where HIV-positive individuals are identified and immediately begin a course of antiretroviral treatment, regardless of the length of time they have been infected. However, the foundations of this modelling ignored the effects of drug resistance on the epidemic. It also disregarded the heterogeneity of behaviour changes that may occur, as a result of education that some individuals may receive upon testing and treatment. We formulate an HIV/AIDS model to theoretically investigate how testing, educating HIV-positive cases, treatment, and drug resistance affect the HIV epidemic. We consider a variety of circumstances: both when education is included and not included, when testing and treatment are linked or are separate, when education is only partly effective, and when treatment leads to drug resistance. We show that education, if it is properly harnessed, can be a force strong enough to overcome the effects of antiretroviral drug resistance; however, in the absence of education, “test and treat” is likely to make the epidemic worse.

Article information

J. Appl. Math., Volume 2015 (2015), Article ID 781270, 19 pages.

First available in Project Euclid: 17 August 2015

Permanent link to this document

Digital Object Identifier

Mathematical Reviews number (MathSciNet)


Al-arydah, Mo’tassem; Smith?, Robert. Adding Education to “Test and Treat”: Can We Overcome Drug Resistance?. J. Appl. Math. 2015 (2015), Article ID 781270, 19 pages. doi:10.1155/2015/781270.

Export citation


  • F. I. Bastos, C. M. Buchalla, J. R. de C.M. Ayres, and L. J. da Silva, “Brazilian response to the HIV/AIDS epidemic, 2001–2005,” Revista de Saude Publica, vol. 40, pp. 1–4, 2006.
  • C. Beyrer, “HIV epidemiology update and transmission factors: risks and risk contexts–-16th International AIDS Conference epidemiology plenary,” Clinical Infectious Diseases, vol. 44, no. 7, pp. 981–987, 2007.
  • WHO, 2006, the-world/global-aids-overview/.
  • R. A. Fowler, N. K. J. Adhikari, and S. Bhagwanjee, “Clinical review: Critical care in the global context–-disparities in burden of illness, access, and economics,” Critical Care, vol. 12, no. 5, article 225, 2008.
  • D. Desai, G. Wu, and M. H. Zaman, “Tackling HIV through robust diagnostics in the developing world: current status and future opportunities,” Lab on a Chip, vol. 11, no. 2, pp. 194–211, 2011.
  • S. M. Hammer, J. J. Eron Jr., P. Reiss et al., “Antiretroviral treatment of adult HIV infection: 2008 Recommendations of the international AIDS society-USA panel,” Journal of the American Medical Association, vol. 300, no. 5, pp. 555–570, 2008.
  • R. E. Miron and R. J. Smith?, “Modelling imperfect adherence to HIV induction therapy,” BMC Infectious Diseases, vol. 10, article 6, 2010.
  • D. R. Bangsberg, “Preventing HIV antiretroviral resistance through better monitoring of treatment adherence,” Journal of Infectious Diseases, vol. 197, no. 3, pp. S272–S278, 2008.
  • R. J. Smith?, J. T. Okano, J. S. Kahn, E. N. Bodine, and S. Blower, “Evolutionary dynamics of complex networks of HIV drug-resistant strains: the case of San Francisco,” Science, vol. 327, no. 5966, pp. 697–701, 2010.
  • V. Supervie, M. Barrett, J. S. Kahn et al., “Modeling dynamic interactions between pre-exposure prophylaxis interventions & treatment programs: predicting HIV transmission & resistance,” Scientific Reports, vol. 1, article 185, 2011.
  • U. L. Abbas, R. Glaubius, G. Hood, and J. W. Mellors, “Antiretroviral treatment, preexposure prophylaxis, and drug resistance in sub-saharan Africa: a consensus among mathematical models,” Journal of Infectious Diseases, vol. 209, no. 1, pp. 164–166, 2014.
  • J. T. Okano and S. Blower, “HIV treatment, preexposure prophylaxis, and drug resistance: reconciling conflicting predictions from mathematical models,” Journal of Infectious Diseases, vol. 209, no. 1, pp. 163–164, 2014.
  • B. E. Nichols, K. C. E. Sigaloff, C. Kityo et al., “Averted HIV infections due to expanded antiretroviral treatment eligibility offsets risk of transmitted drug resistance: a modeling study,” AIDS, vol. 28, no. 1, pp. 73–83, 2014.
  • R. M. Granich, C. F. Gilks, C. Dye, K. M. De Cock, and B. G. Williams, “Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model,” The Lancet, vol. 373, no. 9657, pp. 48–57, 2009.
  • B. G. Wagner and S. Blower, “Voluntary universal testing and treatment is unlikely to lead to HIV elimination: a modeling analysis,” Nature Precedings, vol. 3917, article 1, 2009.
  • R. M. Granich, J. G. Kahn, R. Bennett et al., “Expanding ART for treatment and prevention of HIV in South Africa: estimated cost and cost-effectiveness 2011–2050,” PLoS ONE, vol. 7, no. 2, Article ID e30216, 2012.
  • J. R. Hargreaves, C. P. Bonell, T. Boler et al., “Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa,” AIDS, vol. 22, no. 3, pp. 403–414, 2008.
  • M. Barry, “The tail end of guinea worm–-global eradication without a drug or a vaccine,” The New England Journal of Medicine, vol. 356, no. 25, pp. 2561–2564, 2007.
  • J. C. Phillips, A. Webel, C. D. Rose et al., “Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America,” BMC Public Health, vol. 13, article 736, 2013.
  • D. B. Kirby, B. A. Laris, and L. A. Rolleri, “Sex and HIV education programs: their impact on sexual behaviors of young people throughout the world,” Journal of Adolescent Health, vol. 40, no. 3, pp. 206–217, 2007.
  • M. Bateganya, O. A. Abdulwadud, and S. M. Kiene, “Home-based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing,” The Cochrane Database of Systematic Reviews, no. 7, Article ID CD006493, 2010.
  • H. van Rooyen, R. V. Barnabas, J. M. Baeten et al., “High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa,” Journal of Acquired Immune Deficiency Syndromes, vol. 64, no. 1, pp. e1–e8, 2013.
  • G. Ramjee, E. Gouws, A. Andrews, L. Myer, and A. E. Weber, “The acceptability of a vaginal microbicide among South African Men,” International Family Planning Perspectives, vol. 27, no. 4, pp. 164–170, 2001.
  • N. Crepaz and G. Marks, “Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings,” AIDS, vol. 16, no. 2, pp. 135–149, 2002.
  • A. S. Erulkar, L. I. A. Ettyang, C. Onoka, F. K. Nyagah, and A. Muyonga, “Behavior change evaluation of a culturally consistent reproductive health program for young Kenyans,” International Family Planning Perspectives, vol. 30, no. 2, pp. 58–67, 2004.
  • Global Campaign for Education, 2014, Oxfam.pdf.
  • S. Cassels, S. J. Clark, and M. Morris, “Mathematical models for HIV transmission dynamics,” Journal of Acquired Immune Deficiency Syndromes, vol. 47, supplement 1, pp. S34–S39, 2008.
  • S. M. Goodreau, “A decade of modelling research yields considerable evidence for the importance of concurrency: a response to Sawers and Stillwaggon,” Journal of the International AIDS Society, vol. 14, article 12, 2011.
  • A. S. Khanna, S. M. Goodreau, P. M. Gorbach, E. Daar, and S. J. Little, “Modeling the impact of post-diagnosis behavior change on HIV prevalence in Southern California men who have sex with men (MSM),” AIDS and Behavior, vol. 18, no. 8, pp. 1523–1531, 2014.
  • A. S. Khanna, D. T. Dimitrov, and S. M. Goodreau, “What can mathematical models tell us about the relationship between circular migrations and HIV transmission dynamics?” Mathematical Biosciences and Engineering, vol. 11, no. 5, pp. 1065–1090, 2014.
  • B. G. Williams, J. O. Lloyd-Smith, E. Gouws et al., “The potential impact of male circumcision on HIV in sub-Saharan Africa,” PLoS Medicine, vol. 3, no. 7, pp. 1032–1040, 2006.
  • R. J. Smith and S. M. Blower, “Could disease-modifying HIV vaccines cause population-level perversity?” The Lancet Infectious Diseases, vol. 4, no. 10, pp. 636–639, 2004.
  • D. Donnell, J. M. Baeten, J. Kiarie et al., “Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis,” The Lancet, vol. 375, no. 9731, pp. 2092–2098, 2010.
  • C. P. Bhunu, S. Mushayabasa, H. Kojouharov, and J. M. Tchuenche, “Mathematical analysis of an HIV/AIDS model: impact of educational programs and abstinence in sub-Saharan Africa,” Journal of Mathematical Modelling and Algorithms, vol. 10, no. 1, pp. 31–55, 2011.
  • J. A. Catania, S. M. Kegeles, and T. J. Coates, “Towards an understanding of risk behavior: an AIDS risk reduction model (ARRM),” Health Education Quarterly, vol. 17, no. 1, pp. 53–72, 1990.
  • J. D. Fisher, W. A. Fisher, S. S. Williams, and T. E. Malloy, “Empirical tests of an information-motivation-behavioural skills model of AIDS-preventive behavior with gay men and heterosexual university students,” Health Psychology, vol. 13, no. 3, pp. 238–250, 1994.
  • J. D. Fisher, W. A. Fisher, S. J. Misovich, D. L. Kimble, and T. E. Malloy, “Changing AIDS risk behavior: effects of an intervention emphasizing AIDS risk reduction information, motivation, and behavioral skills in a college student population,” Health Psychology, vol. 15, no. 2, pp. 114–123, 1996.
  • L. Libresco, The U.K.s New at-Home HIV Test Is Better Than Anything We Have in the U.S., 2015, test-is-better-than-anything-we-have-in-the-u-s/.
  • J. M. Heffernan, R. J. Smith, and L. M. Wahl, “Perspectives on the basic reproductive ratio,” Journal of the Royal Society Interface, vol. 2, no. 4, pp. 281–293, 2005.
  • C. P. Bhunu, W. Garira, and G. Magombedze, “Mathematical analysis of a two strain HIV/AIDS model with antiretroviral treatment,” Acta Biotheoretica, vol. 57, no. 3, pp. 361–381, 2009.
  • J. Li, D. Blakeley, and R. J. Smith?, “The failure of ${R}_{0}$,” Computational and Mathematical Methods in Medicine, vol. 2011, Article ID 527610, 17 pages, 2011.
  • P. van den Driessche and J. Watmough, “Reproduction numbers and sub-threshold endemic equilibria for compartmental models of disease transmission,” Mathematical Biosciences, vol. 180, pp. 29–48, 2002.
  • S. M. Blower and H. Dowlatabadi, “Sensitivity and uncertainty analysis of complex models of disease transmission: an HIV model, as an example,” International Statistical Review, vol. 62, no. 2, pp. 229–243, 1994. \endinput