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Bekker-Nielsen Dunbar M. Transmission matrices used in epidemiologic modelling. Infect Dis Model 2024; 9:185-194. [PMID: 38249428 PMCID: PMC10796975 DOI: 10.1016/j.idm.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 01/23/2024] Open
Abstract
Mixing matrices are included in infectious disease models to reflect transmission opportunities between population strata. These matrices were originally constructed on the basis of theoretical considerations and most of the early work in this area originates from research on sexually transferred diseases in the 80s, in response to AIDS. Later work in the 90s populated these matrices on the basis of survey data gathered to capture transmission risks for respiratory diseases. We provide an overview of developments in the construction of matrices for capturing transmission opportunities in populations. Such transmission matrices are useful for epidemiologic modelling to capture within and between stratum transmission and can be informed from theoretical mixing assumptions, informed by empirical evidence gathered through investigation as well as generated on the basis of data. Links to summary measures and threshold conditions are also provided.
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Affiliation(s)
- M. Bekker-Nielsen Dunbar
- Centre for Research on Pandemics & Society, OsloMet – Oslo Metropolitan University, HG536, Holbergs gate 1, Oslo, 0166, Norway
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Zelnick JR, Daftary A, Hwang C, Labar AS, Boodhram R, Maharaj B, Wolf AK, Mondal S, Amico KR, Orrell C, Seepamore B, Friedland G, Padayatchi N, O'Donnell MR. Electronic dose monitoring identifies a high-risk subpopulation in the treatment of drug-resistant tuberculosis and HIV. Clin Infect Dis 2020; 73:e1901-e1910. [PMID: 33053186 DOI: 10.1093/cid/ciaa1557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In generalized drug-resistant tuberculosis (DR-TB) HIV epidemics, identifying subpopulations at high risk for treatment failure and loss to care is critically important to improve treatment outcomes and prevent amplification of drug resistance. We hypothesized that an electronic dose-monitoring (EDM) device could empirically identify adherence-challenged patients and that a mixed-methods approach would characterize treatment challenges. METHODS A prospective study of DR-TB HIV patients on antiretroviral therapy (ART) initiating bedaquiline-containing regimens in KwaZulu-Natal, South Africa. Separate EDM devices measured adherence for bedaquiline and ART. Patients with low adherence (<85%) to both bedaquiline and ART were identified as high-risk for poor outcomes. Baseline survey, study visit notes and focus group discussions characterized treatment challenges. RESULTS From December 2016-February 2018, 32 of 198 (16%) enrolled DR-TB HIV patients were identified as dual adherence-challenged. In a multivariate model including baseline characteristics, only receiving a disability grant was significantly associated with dual non-adherence at 6-months. Mixed-methods identified treatment barriers including, alcohol abuse, family conflicts, and mental health issues. Compared to adherent patients, dual-adherence challenged patients struggled to prioritize treatment and lacked support, and dual adherence-challenged patients experienced higher rates of detectable HIV viral load and mortality compared to more adherent patients. CONCLUSION EDM empirically identified a subpopulation of DR-TB HIV patients with dual adherence challenges early in treatment. Mixed-methods revealed intense psychosocial, behavioral, and structural barriers to care in this subpopulation. Our data supports developing differential, patient-centered, adherence support interventions focused on psychosocial and structural challenges for subpopulations of at-risk DR-TB HIV patients.
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Affiliation(s)
- Jennifer R Zelnick
- Graduate School of Social Work, Touro College and University System, NY, NY USA
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, School of Global Health, York University, Toronto, Ontario Canada.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Christina Hwang
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, NY, USA
| | - Amy S Labar
- Vagelos College of Physician & Surgeons, Columbia University, NY, NY USA
| | - Resha Boodhram
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Bhavna Maharaj
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Allison K Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, NY, NY, USA
| | - Shinjini Mondal
- Department of Family Medicine, McGill University, Montreal, Canada
| | - K Rivet Amico
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa
| | | | | | - Nesri Padayatchi
- CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Max R O'Donnell
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, NY, USA.,CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.,Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, NY, NY, USA
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HCV incidence is associated with injecting partner age and HCV serostatus mixing in young adults who inject drugs in San Francisco. PLoS One 2019; 14:e0226166. [PMID: 31821365 PMCID: PMC6903751 DOI: 10.1371/journal.pone.0226166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND HCV incidence is increasing in the US, notably among younger people who inject drugs (PWID). In a cohort of young adult (age<30 years) PWID in San Francisco we examined whether 'injecting partner mixing' factors, i.e. age of partner and knowledge of their HCV serostatus, were associated with HCV transmission. METHODS In 448 susceptible PWID studied prospectively. All participants were asked to report characteristics and behaviors they engaged in with up to 3 injecting partners defined as "people whom you injected the most with" in the past month". These partnerships did not specify that drugs or injecting equipment was shared. HCV incidence was estimated by age of up to 3 injecting partners, categorized as: (i) all <30; (ii) mixed-age (<&≥30); and (iii) all ≥30 years and perceived knowledge of the HCV status of participants' injecting partners' HCV status. Interaction was evaluated between partnership age categories and perceived HCV status of partners. RESULTS Between 2006-2018, overall HCV incidence (/100 person years observation [pyo]) was 19.4 (95% CI: 16.4, 22.9). Incidence was highest in those with mixed-age partnerships: 28.5 (95% CI: 21.8, 37.1) and those whose partners were all <30 (23.9; 95% CI: 18.8, 30.4), and lowest if partners were ≥30 (7.5; 95% CI: 4.8, 11.8). In a multivariable analyses adjusting for age, sex (of index), injection frequency, and injection partnership 'monogamy', we found evidence for an interaction: the highest HCV incidence was seen in PWID whose partners were all <30 and who knew at least one of their partners was HCV-positive (58.9, 95% CI: 43.3, 80.0; p<0.01). CONCLUSIONS Younger injectors are more likely to acquire HCV from their similarly-aged peers, than older injecting partners. Protective seroadaptive behavior may contribute to reduce incidence. These findings can inform new HCV prevention approaches for young PWID needed to curb the HCV epidemic.
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Lancaster KE, Hoffman IF, Hanscom B, Ha TV, Dumchev K, Susami H, Rose S, Go VF, Reifeis SA, Mollan KR, Hudgens MG, Piwowar‐Manning EM, Richardson P, Dvoriak S, Djoerban Z, Kiriazova T, Zeziulin O, Djauzi S, Ahn CV, Latkin C, Metzger D, Burns DN, Sugarman J, Strathdee SA, Eshleman SH, Clarke W, Donnell D, Emel L, Sunner LE, McKinstry L, Sista N, Hamilton EL, Lucas JP, Duong BD, Van Vuong N, Sarasvita R, Miller WC. Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis. J Int AIDS Soc 2018; 21:e25195. [PMID: 30350406 PMCID: PMC6198168 DOI: 10.1002/jia2.25195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. METHODS We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. RESULTS The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. CONCLUSIONS While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.
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Affiliation(s)
- Kathryn E Lancaster
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
| | - Irving F Hoffman
- Division of Infectious DiseasesSchool of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Tran Viet Ha
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Hepa Susami
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | - Vivian F Go
- Department of Health BehaviorGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Sarah A Reifeis
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Katie R Mollan
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | - Michael G Hudgens
- Department of BiostatisticsGilings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillNCUSA
- Center for AIDS Research (CFAR)School of MedicineThe University of North Carolina at Chapel HillChapel HillNCUSA
| | | | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health PolicyKyivUkraine
- Academy of Labor, Social Relations and TourismKyivUkraine
| | - Zubairi Djoerban
- University of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | | | | | | | | | - Carl Latkin
- Department of Health, Behavior, and SocietyJohns Hopkins UniversityBaltimoreMDUSA
| | - David Metzger
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David N Burns
- Division of AIDSNational Institute of Allergy and Infectious DiseasesU.S. National Institutes of HealthBethesdaMDUSA
| | - Jeremy Sugarman
- Department of MedicineBerman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Steffanie A Strathdee
- Department of MedicineSchool of MedicineUniversity of California San DiegoSan DiegoCAUSA
| | | | - William Clarke
- School of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | | | | | | | | | | | | | | | - Bui D Duong
- Vietnam Authority of HIV/AIDS Control ‐ Ministry of HealthHanoiVietnam
| | | | | | - William C Miller
- Division of EpidemiologyCollege of Public HealthThe Ohio State UniversityColumbusOHUSA
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