With the world's largest national treatment programme and over 340 000 incident cases annually, the response to HIV in South Africa is hotly contested and there is sometimes a dissonance between activism, science and policy. Too often, policy, whilst well intentioned, is informed only by epidemiological data. The state of the healthcare system and sociocultural factors drive and shape the epidemic and its response. By analysis of the financial, infrastructural, human resources for health, and governance landscape in South Africa, we assess the feasibility and associated costs of implementing a universal test and treat programme. We situate a universal test and treat strategy within the governance, fiscal, human resources for health, and infrastructural landscape in South Africa. We argue that the response to the epidemic must be forward thinking, progressive and make the most of the benefits from treatment as prevention. However, the logistics of implementing a universal test and treat strategy mean that this option is problematic in the short term. We recommend a health systems strengthening HIV treatment and prevention approach that includes scaling up treatment (for treatment and prevention) along with a range of other prevention strategies.

中文翻译：

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消除科学与政策分歧：扩大南非抗逆转录病毒疗法的现实。

凭借世界上最大的国民治疗计划以及每年超过340,000的事件病例，南非对艾滋病毒的应对备受争议，行动主义，科学与政策之间有时会出现不协调的情况。通常，政策虽然有很好的意图，但只能从流行病学数据中得知。卫生保健系统的状态和社会文化因素驱动并塑造了这一流行病及其对策。通过分析南非在卫生方面的财务，基础设施，人力资源以及治理状况，我们评估了实施通用测试和治疗计划的可行性和相关成本。我们在南非的治理，财政，卫生人力资源和基础设施领域内制定了通用测试和治疗策略。我们认为，对这一流行病的反应必须是前瞻性的，进步的，并要充分利用作为预防措施的治疗所带来的好处。但是，实施通用测试和治疗策略的后勤工作意味着该选择在短期内是有问题的。我们建议建立加强艾滋病毒治疗和预防方法的卫生系统，其中应包括扩大治疗范围（用于治疗和预防）以及一系列其他预防策略。