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Knight J, Ma H, Sithole B, Khumalo L, Wang L, Schwartz S, Muzart L, Matse S, Mnisi Z, Kaul R, Escobar M, Baral S, Mishra S. Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.16.24302584. [PMID: 38405846 PMCID: PMC10889039 DOI: 10.1101/2024.02.16.24302584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Inequalities in the antiretroviral therapy (ART) cascade across subpopulations remain an ongoing challenge in the global HIV response. Eswatini achieved the UNAIDS 95-95-95 targets by 2020, with differentiated programs to minimize inequalities across subpopulations, including for female sex workers (FSW) and their clients. We sought to estimate additional HIV infections expected in Eswatini if cascade scale-up had not been equal, and under which epidemic conditions these inequalities could have the largest influence. Methods Drawing on population-level and FSW-specific surveys in Eswatini, we developed a compartmental model of heterosexual HIV transmission which included eight subpopulations and four sexual partnership types. We calibrated the model to stratified HIV prevalence, incidence, and ART cascade data. Taking observed cascade scale-up in Eswatini as the base-case-reaching 95-95-95 in the overall population by 2020-we defined four counterfactual scenarios in which the population overall reached 80-80-90 by 2020, but where FSW, clients, both, or neither were disproportionately left behind, reaching only 60-40-80. We quantified relative additional cumulative HIV infections by 2030 in counterfactual vs base-case scenarios. We further estimated linear effects of viral suppression gap among FSW and clients on additional infections by 2030, plus effect modification by FSW/client population sizes, rates of turnover, and HIV prevalence ratios. Results Compared with the base-case scenario, leaving behind neither FSW nor their clients led to the fewest additional infections by 2030: median (95% credible interval) 14.9 (10.4, 18.4)% vs 26.3 (19.7, 33.0)% if both were left behind-a 73 (40, 149)% increase. The effect of lower cascade on additional infections was larger for clients vs FSW, and both effects increased with population size and relative HIV incidence. Conclusions Inequalities in the ART cascade across subpopulations can undermine the anticipated prevention impacts of cascade scale-up. As Eswatini has shown, addressing inequalities in the ART cascade, particularly those that intersect with high transmission risk, could maximize incidence reductions from cascade scale-up.
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Affiliation(s)
- Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto
- Institute of Medical Science, University of Toronto
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Unity Health Toronto
| | | | | | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto
| | | | | | | | | | - Rupert Kaul
- Division of Infectious Diseases, Department of Medicine, University of Toronto
| | | | - Stefan Baral
- Bloomberg School of Public Health, Johns Hopkins University
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto
- Institute of Medical Science, University of Toronto
- Division of Infectious Diseases, Department of Medicine, University of Toronto
- Dalla Lana School of Public Health, University of Toronto
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Rautenbach SP, Whittles LK, Meyer-Rath G, Jamieson L, Chidarikire T, Johnson LF, Imai-Eaton JW. Future HIV epidemic trajectories in South Africa and projected long-term consequences of reductions in general population HIV testing: a mathematical modelling study. Lancet Public Health 2024; 9:e218-e230. [PMID: 38553141 PMCID: PMC11000585 DOI: 10.1016/s2468-2667(24)00020-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND After successful intensive interventions to rapidly increase HIV awareness, coverage of antiretroviral therapy (ART), and viral suppression, HIV programmes in eastern and southern Africa are considering scaling back of some interventions, such as widespread general population HIV testing. We aimed to model whether scaling back of general population HIV testing in South Africa could result in a resurgence of the HIV epidemic or substantial slowing of declines in HIV incidence, resulting in increased long-term ART. METHODS In this modelling study, we used the Thembisa 4.5 model (a deterministic compartmental model of HIV transmission in South Africa) to project the South African HIV epidemic to 2100 assuming the continuation of 2022 epidemiological conditions and HIV programme implementation. We assessed how implementing reductions in general population HIV testing services in 2025 (while maintaining antenatal, symptom-based, and risk-based testing modalities and other HIV prevention services at 2022 levels) would affect HIV incidence and prevalence among people aged 15-49 years, the year in which incidence would reach one per 1000 people aged 15-49 years (the threshold for virtual elimination of HIV), and associated costs, as well as numbers of additional new HIV infections and AIDS-related deaths. We also modelled the effects of delaying reductions in general population testing services by 5-year increments. Additionally, we modelled the potential effects of reductions in general population testing services in combination with increases or decreases in ART interruption rates (ie, the annual rate at which people who are on ART discontinue ART) and condom usage in 2025-35. FINDINGS If general population HIV testing services and the HIV risk environment of 2022 were maintained, we projected that HIV incidence would steadily decline from 4·95 (95% CI 4·40-5·34) per 1000 population in 2025 to 0·14 (0·05-0·31) per 1000 in 2100, and that the so-called virtual elimination threshold of less than one new infection per 1000 population per year would be reached in 2055 (95% CI 2051-2060). Scaling back of general population HIV testing services by 25%, 50%, or 75% in 2025 delayed time to reaching the virtual elimination threshold by 5, 13, or 35 years, respectively, whereas complete cessation of general population testing would result in the threshold not being attained by 2100. Although the incidence of HIV continued to fall when general HIV testing services were reduced, our modelling suggested that, with reductions of between 25% and 100%, between 396 000 (95% CI 299 000-474 000) and 2·50 million (1·97 million-2·98 million) additional HIV infections and between 115 000 (94 000-135 000) and 795 000 (670 000-926 000) additional AIDS-related deaths would occur between 2025 and 2075, depending on the extent of reduction in testing. Delaying reductions in general population HIV testing services for 5-25 years mitigated some of these effects. HIV testing accounted for only 5% of total programmatic costs at baseline; reducing testing moderately reduced short-term total annual costs, but increased annual costs after 25 years. Increases in ART interruption and reductions in condom usage were projected to slow the decline in incidence and increase the coverage of general HIV testing services required to control transmission but did not cause rapid resurgence in HIV infections. INTERPRETATION Our modelling suggests that scaling back of general population HIV testing would not result in a resurgence of HIV infections, but would delay attainment of incidence-reduction targets and result in long-term increases in HIV infections, AIDS-related deaths, and costs (via increased need for ART provision). HIV programmes need to balance short-term potential resource savings with long-term epidemic control objectives. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Stefan P Rautenbach
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Lilith K Whittles
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Global Health, School of Public Health, Boston University, Boston, MA, USA; South African Department of Science and Innovation and National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Department of Science and Innovation and National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Thato Chidarikire
- HIV and AIDS and STI Unit, National Department of Health, Johannesburg, South Africa
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jeffrey W Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Popoola VO, Kagaayi J, Ssekasanvu J, Ssekubugu R, Kigozi G, Ndyanabo A, Nalugoda F, Chang LW, Lutalo T, Tobian AAR, Kabatesi D, Alamo S, Mills LA, Kigozi G, Wawer MJ, Santelli J, Gray RH, Reynolds SJ, Serwadda D, Lessler J, Grabowski MK. HIV epidemiologic trends among occupational groups in Rakai, Uganda: A population-based longitudinal study, 1999-2016. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002891. [PMID: 38377078 PMCID: PMC10878534 DOI: 10.1371/journal.pgph.0002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including female bar and restaurant work and male transportation work. However, data on changes in population prevalence of HIV infection and HIV incidence within occupations following mass scale-up of African HIV treatment and prevention programs is very limited. We evaluated prospective data collected between 1999 and 2016 from the Rakai Community Cohort Study, a longitudinal population-based study of 15- to 49-year-old persons in Uganda. Adjusted prevalence risk ratios for overall, treated, and untreated, prevalent HIV infection, and incidence rate ratios for HIV incidence with 95% confidence intervals were estimated using Poisson regression to assess changes in HIV outcomes by occupation. Analyses were stratified by gender. There were 33,866 participants, including 19,113 (56%) women. Overall, HIV seroprevalence declined in most occupational subgroups among men, but increased or remained mostly stable among women. In contrast, prevalence of untreated HIV substantially declined between 1999 and 2016 in most occupations, irrespective of gender, including by 70% among men (12.3 to 4.2%; adjPRR = 0.30; 95%CI:0.23-0.41) and by 78% among women (14.7 to 4.0%; adjPRR = 0.22; 95%CI:0.18-0.27) working in agriculture, the most common self-reported primary occupation. Exceptions included men working in transportation. HIV incidence similarly declined in most occupations, but there were no reductions in incidence among female bar and restaurant workers, women working in local crafts, or men working in transportation. In summary, untreated HIV infection and HIV incidence have declined within most occupational groups in Uganda. However, women working in bars/restaurants and local crafts and men working in transportation continue to have a relatively high burden of untreated HIV and HIV incidence, and as such, should be considered priority populations for HIV programming.
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Affiliation(s)
- Victor O. Popoola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Joseph Kagaayi
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | | | | | - Larry W. Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Aaron A. R. Tobian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Donna Kabatesi
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | - Stella Alamo
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | - Lisa A. Mills
- Division of Global HIV and TB, Centers for Disease Control and Prevention Uganda, Kampala, Uganda
| | | | - Maria J. Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | - John Santelli
- Department of Population and Family Health and Pediatrics, Columbia University, New York, New York, United States of America
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Steven J. Reynolds
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - M. Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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Sawe SJ, Mugo R, Wilson-Barthes M, Osetinsky B, Chrysanthopoulou SA, Yego F, Mwangi A, Galárraga O. Gaussian process emulation to improve efficiency of computationally intensive multidisease models: a practical tutorial with adaptable R code. BMC Med Res Methodol 2024; 24:26. [PMID: 38281017 PMCID: PMC10821551 DOI: 10.1186/s12874-024-02149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The rapidly growing burden of non-communicable diseases (NCDs) among people living with HIV in sub-Saharan Africa (SSA) has expanded the number of multidisease models predicting future care needs and health system priorities. Usefulness of these models depends on their ability to replicate real-life data and be readily understood and applied by public health decision-makers; yet existing simulation models of HIV comorbidities are computationally expensive and require large numbers of parameters and long run times, which hinders their utility in resource-constrained settings. METHODS We present a novel, user-friendly emulator that can efficiently approximate complex simulators of long-term HIV and NCD outcomes in Africa. We describe how to implement the emulator via a tutorial based on publicly available data from Kenya. Emulator parameters relating to incidence and prevalence of HIV, hypertension and depression were derived from our own agent-based simulation model and other published literature. Gaussian processes were used to fit the emulator to simulator estimates, assuming presence of noise for design points. Bayesian posterior predictive checks and leave-one-out cross validation confirmed the emulator's descriptive accuracy. RESULTS In this example, our emulator resulted in a 13-fold (95% Confidence Interval (CI): 8-22) improvement in computing time compared to that of more complex chronic disease simulation models. One emulator run took 3.00 seconds (95% CI: 1.65-5.28) on a 64-bit operating system laptop with 8.00 gigabytes (GB) of Random Access Memory (RAM), compared to > 11 hours for 1000 simulator runs on a high-performance computing cluster with 1500 GBs of RAM. Pareto k estimates were < 0.70 for all emulations, which demonstrates sufficient predictive accuracy of the emulator. CONCLUSIONS The emulator presented in this tutorial offers a practical and flexible modelling tool that can help inform health policy-making in countries with a generalized HIV epidemic and growing NCD burden. Future emulator applications could be used to forecast the changing burden of HIV, hypertension and depression over an extended (> 10 year) period, estimate longer-term prevalence of other co-occurring conditions (e.g., postpartum depression among women living with HIV), and project the impact of nationally-prioritized interventions such as national health insurance schemes and differentiated care models.
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Affiliation(s)
- Sharon Jepkorir Sawe
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
| | - Richard Mugo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Faith Yego
- Department of Health Policy Management & Human Nutrition, Moi University School Public Health, Eldoret, Kenya
| | - Ann Mwangi
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Mathematics, Physics & Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya
| | - Omar Galárraga
- Academic Model Providing Access to Healthcare, Eldoret, Kenya.
- Department of Health Services, Policy and Practice, and International Health Institute, Brown University School of Public Health, Providence, RI, USA.
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Pitpitan EV, Wiginton JM, Bejarano-Romero R, Baker DA. Promoting HIV care continuum outcomes among people who use drugs and alcohol: a systematic review of randomized trials evaluating behavioral HIV care interventions published from 2011 to 2023. BMC Public Health 2023; 23:2182. [PMID: 37936103 PMCID: PMC10629072 DOI: 10.1186/s12889-023-17113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Substance use remains a robust predictor of HIV infection and a serious impediment to HIV care continuum progression for people living with HIV. The primary research question of this systematic review is focused on understanding the extent to which behavioral HIV care interventions have been efficacious in helping people who live with HIV and who use substances along the HIV care continuum. METHODS Using PubMed and ProQuest databases, we performed a systematic review of randomized trials of behavioral HIV care continuum interventions among people who use substances published from 2011 to August 2023, since the beginning of the treatment-as-prevention era. RESULTS We identified 11 studies (total participants: N = 5635), ten intentionally targeting substance-using populations. Four studies involved samples using ≥ 1 substance (e.g., alcohol, opioids, stimulants, marijuana); four involved injection drug use; one involved methamphetamine use; and one involved alcohol use. One study targeted a population with incidental substance use (i.e., alcohol, injection drug use, non-injection drug use reported in most participants). Each study defined one or more HIV care outcomes of interest. Viral suppression was an outcome targeted in 9/11 studies, followed by uptake of antiretroviral therapy (ART; 7/11), ART adherence (6/11), retention in care (5/11), and linkage to care (3/11). While most (nine) of the studies found significant effects on at least one HIV care outcome, findings were mostly mixed. Mediated (2/11) and moderated (2/11) effects were minimally examined. CONCLUSIONS The results from this systematic review demonstrate mixed findings concerning the efficacy of previous HIV care interventions to improve HIV care continuum outcomes among people who use substances. However, heterogeneity of study components (e.g., diversity of substances used/assessed, self-report vs. objective measures, attrition) prevent broad deductions or conclusions about the amenability of specific substance-using populations to HIV care intervention. More coordinated, comprehensive, and targeted efforts are needed to promote and disentangle intervention effects on HIV care continuum outcomes among substance-using populations.
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Affiliation(s)
- Eileen V Pitpitan
- School of Social Work, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4119, USA.
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - John Mark Wiginton
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Raul Bejarano-Romero
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
| | - Dania Abu Baker
- San Diego State University, University of California-San Diego Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego, CA, USA
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Moolla H, Phillips A, Ten Brink D, Mudimu E, Stover J, Bansi-Matharu L, Martin-Hughes R, Wulan N, Cambiano V, Smith J, Bershteyn A, Meyer-Rath G, Jamieson L, Johnson LF. A quantitative assessment of the consistency of projections from five mathematical models of the HIV epidemic in South Africa: a model comparison study. BMC Public Health 2023; 23:2119. [PMID: 37891514 PMCID: PMC10612295 DOI: 10.1186/s12889-023-16995-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Mathematical models are increasingly used to inform HIV policy and planning. Comparing estimates obtained using different mathematical models can test the robustness of estimates and highlight research gaps. As part of a larger project aiming to determine the optimal allocation of funding for HIV services, in this study we compare projections from five mathematical models of the HIV epidemic in South Africa: EMOD-HIV, Goals, HIV-Synthesis, Optima, and Thembisa. METHODS The five modelling groups produced estimates of the total population, HIV incidence, HIV prevalence, proportion of people living with HIV who are diagnosed, ART coverage, proportion of those on ART who are virally suppressed, AIDS-related deaths, total deaths, and the proportion of adult males who are circumcised. Estimates were made under a "status quo" scenario for the period 1990 to 2040. For each output variable we assessed the consistency of model estimates by calculating the coefficient of variation and examining the trend over time. RESULTS For most outputs there was significant inter-model variability between 1990 and 2005, when limited data was available for calibration, good consistency from 2005 to 2025, and increasing variability towards the end of the projection period. Estimates of HIV incidence, deaths in people living with HIV, and total deaths displayed the largest long-term variability, with standard deviations between 35 and 65% of the cross-model means. Despite this variability, all models predicted a gradual decline in HIV incidence in the long-term. Projections related to the UNAIDS 95-95-95 targets were more consistent, with the coefficients of variation below 0.1 for all groups except children. CONCLUSIONS While models produced consistent estimates for several outputs, there are areas of variability that should be investigated. This is important if projections are to be used in subsequent cost-effectiveness studies.
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Affiliation(s)
- Haroon Moolla
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa.
| | | | | | - Edinah Mudimu
- Department of Decision Sciences, University of South Africa, Pretoria, South Africa
| | | | | | | | | | | | | | - Anna Bershteyn
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Gesine Meyer-Rath
- Center for Global Health and Development, Boston University, Boston, USA
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Microbiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Anzio Road, Cape Town, 7925, Observatory, South Africa
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7
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Davis K, Pickles M, Gregson S, Hargreaves JR, Ayles H, Bock P, Pliakas T, Thomas R, Ohrnberger J, Bwalya J, Bell-Mandla N, Shanaube K, Probert W, Hoddinott G, Bond V, Hayes R, Fidler S, Hauck K. The effect of universal testing and treatment for HIV on health-related quality of life - An analysis of data from the HPTN 071 (PopART) cluster randomised trial. SSM Popul Health 2023; 23:101473. [PMID: 37575363 PMCID: PMC10413193 DOI: 10.1016/j.ssmph.2023.101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/26/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Background HIV treatment has clear Health-Related Quality-of-Life (HRQoL) benefits. However, little is known about how Universal Testing and Treatment (UTT) for HIV affects HRQoL. This study aimed to examine the effect of a combination prevention intervention, including UTT, on HRQoL among People Living with HIV (PLHIV). Methods Data were from HPTN 071 (PopART), a three-arm cluster randomised controlled trial in 21 communities in Zambia and South Africa (2013-2018). Arm A received the full UTT intervention of door-to-door HIV testing plus access to antiretroviral therapy (ART) regardless of CD4 count, Arm B received the intervention but followed national treatment guidelines (universal ART from 2016), and Arm C received standard care. The intervention effect was measured in a cohort of randomly selected adults, over 36 months. HRQoL scores, and the prevalence of problems in five HRQoL dimensions (mobility, self-care, performing daily activities, pain/discomfort, anxiety/depression) were assessed among all participants using the EuroQol-5-dimensions-5-levels questionnaire (EQ-5D-5L). We compared HRQoL among PLHIV with laboratory confirmed HIV status between arms, using adjusted two-stage cluster-level analyses. Results At baseline, 7,856 PLHIV provided HRQoL data. At 36 months, the mean HRQoL score was 0.892 (95% confidence interval: 0.887-0.898) in Arm A, 0.886 (0.877-0.894) in Arm B and 0.888 (0.884-0.892) in Arm C. There was no evidence of a difference in HRQoL scores between arms (A vs C, adjusted mean difference: 0.003, -0.001-0.006; B vs C: -0.004, -0.014-0.005). The prevalence of problems with pain/discomfort was lower in Arm A than C (adjusted prevalence ratio: 0.37, 0.14-0.97). There was no evidence of differences for other HRQoL dimensions. Conclusions The intervention did not change overall HRQoL, suggesting that raising HRQoL among PLHIV might require more than improved testing and treatment. However, PLHIV had fewer problems with pain/discomfort under the full intervention; this benefit of UTT should be maximised during roll-out.
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Affiliation(s)
- Katherine Davis
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Michael Pickles
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Simon Gregson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - James R. Hargreaves
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Triantafyllos Pliakas
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Ranjeeta Thomas
- Department of Health Policy, London School of Economics, London, WC2A 2AE, UK
| | - Julius Ohrnberger
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Justin Bwalya
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Kwame Shanaube
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - William Probert
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK
| | - Katharina Hauck
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - the HPTN 071 (PopART) Study Team
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, W2 1PG, UK
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health, University of Stellenbosch, Cape Town, South Africa
- Department of Health Policy, London School of Economics, London, WC2A 2AE, UK
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LF, UK
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, W2 1PG, UK
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8
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Upton EM, Rudolph AE, Ward PJ, Havens JR, Young AM. Extent and implications of omitted ties on network measures in a longitudinal social network survey of people who use drugs. Drug Alcohol Depend 2022; 238:109554. [PMID: 35850026 PMCID: PMC9514791 DOI: 10.1016/j.drugalcdep.2022.109554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research has revealed under-reporting of personal network members (i.e., alters) in studies involving people who use drugs (PWUD). This analysis (1) characterizes relationships that were more likely to be omitted but later recalled with prompting and (2) identifies network structural characteristics most impacted by these omissions among a sample of PWUD in rural Appalachian Kentucky, an epicenter of the opioid epidemic. METHODS Data were collected through longitudinal assessments as part of the Social Networks Among Appalachian People (SNAP) study (2008-2017). Study participants completed interviewer-administered questionnaires that collected social network data via free-listing at baseline and six-month intervals. At visit 5, after free-listing, interviewers prompted participants with the names of previously reported alters. We used modified Poisson regression with generalized estimating equations to identify individual- and relationship-level characteristics associated with an alter being reported only after prompting. We examined the impact of including vs. excluding relationships reported after prompting on local and global sociometric network measures (i.e., betweenness centrality, bridging, density, mean degree, transitivity, cliques, and 2-cores). RESULTS Relationships reported only after prompting were more likely to be immediate family (Adjusted Prevalence Ratio [APR]:1.29; 95% Confidence Interval [CI]: 1.03-1.63) and less likely to involve sex (APR:0.54; 95% CI: 0.43-0.67). Considerable differences were observed for participant positional rankings of betweenness centrality and bridging, and differences in network density and average degree pre- and post-prompting were statistically significant. CONCLUSION Longitudinal network studies that aim to assess transmission dynamics, information diffusion, or peer influence should consider the effects of omitted relationships.
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Affiliation(s)
- Elizabeth M Upton
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA.
| | - Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Patrick J Ward
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Department of Biostatistics, UNC-Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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9
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Knight J, Kaul R, Mishra S. Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review. Epidemics 2022; 40:100608. [PMID: 35843152 DOI: 10.1016/j.epidem.2022.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/11/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Transmission models provide complementary evidence to clinical trials about the potential population-level incidence reduction attributable to ART (ART prevention impact). Different modelling assumptions about risk heterogeneity may influence projected ART prevention impacts. We sought to review representations of risk heterogeneity in compartmental HIV transmission models applied to project ART prevention impacts in Sub-Saharan Africa. METHODS We systematically reviewed studies published before January 2020 that used non-linear compartmental models of sexual HIV transmission to simulate ART prevention impacts in Sub-Saharan Africa. We summarized data on model structure/assumptions (factors) related to risk and intervention heterogeneity, and explored multivariate ecological associations of ART prevention impacts with modelled factors. RESULTS Of 1384 search hits, 94 studies were included. 64 studies considered sexual activity stratification and 39 modelled at least one key population. 21 studies modelled faster/slower ART cascade transitions (HIV diagnosis, ART initiation, or cessation) by risk group, including 8 with faster and 4 with slower cascade transitions among key populations versus the wider population. In ecological analysis of 125 scenarios from 40 studies (subset without combination intervention), scenarios with risk heterogeneity that included turnover of higher risk groups were associated with smaller ART prevention benefits. Modelled differences in ART cascade across risk groups also influenced the projected ART benefits, including: ART prioritized to key populations was associated with larger ART prevention benefits. Of note, zero of these 125 scenarios considered lower ART coverage among key populations. CONCLUSION Among compartmental transmission models applied to project ART prevention impacts in Sub-Saharan Africa, representations of risk heterogeneity and projected impacts varied considerably. Inclusion/exclusion of risk heterogeneity with turnover, and intervention heterogeneity across risk groups could influence the projected impacts of ART scale-up. These findings highlight a need to capture risk heterogeneity with turnover and cascade heterogeneity when projecting ART prevention impacts.
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Affiliation(s)
- Jesse Knight
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Medical Science, University of Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada; Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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10
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Nkambule R, Philip NM, Reid G, Mnisi Z, Nuwagaba-Biribonwoha H, Ao TT, Ginindza C, Duong YT, Patel H, Saito S, Solmo C, Brown K, Moore CS, Voetsch AC, Bicego G, Bock N, Mhlanga F, Dlamini T, Mabuza K, Zwane A, Sahabo R, Dobbs T, Parekh BS, El-Sadr W, Ryan C, Justman J. HIV incidence, viremia, and the national response in Eswatini: Two sequential population-based surveys. PLoS One 2021; 16:e0260892. [PMID: 34855890 PMCID: PMC8639055 DOI: 10.1371/journal.pone.0260892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/18/2021] [Indexed: 01/01/2023] Open
Abstract
With the highest HIV incidence and prevalence globally, the government of Eswatini started a substantial scale-up of HIV treatment and prevention services in 2011. Two sequential large population-based surveys were conducted before and after service expansion to assess the impact of the national response. Cross-sectional, household-based, nationally representative samples of adults, ages 18 to 49 years, were sampled in 2011 and 2016. We measured HIV prevalence, incidence (recent infection based on limiting antigen ≤1.5 optical density units and HIV RNA ≥1000 copies/mL), viral load suppression (HIV RNA <1000 copies/mL among all seropositive adults) and unsuppressed viremia (HIV RNA ≥1000 copies/mL among all, regardless of HIV status) and assessed for temporal changes by conducting a trend analysis of the log ratio of proportions, using a Z statistic distribution. HIV prevalence remained stable from 2011 to 2016 [32% versus 30%, p = 0.10]. HIV incidence significantly declined 48% [2.48% versus 1.30%, p = 0.01]. Incidence remained higher among women than men [2011: 3.16% versus 1.83%; 2016: 1.76% versus 0.86%], with a smaller but significant relative reduction among women [44%; p = 0.04] than men [53%; p = 0.09]. The proportion of seropositive adults with viral load suppression significantly increased from 35% to 71% [p < .001]. The proportion of the total adult population with unsuppressed viremia decreased from 21% to 9% [p < .001]. National HIV incidence in Eswatini decreased by nearly half and viral load suppression doubled over a five-year period. Unsuppressed viremia in the total population decreased 58%. These population-based findings demonstrate the national impact of expanded HIV services in a hyperendemic country.
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Affiliation(s)
| | - Neena M. Philip
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Giles Reid
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | | | - Harriet Nuwagaba-Biribonwoha
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
- ICAP at Columbia University, Mailman School of Public Health, Mbabane, Eswatini
| | - Tony T. Ao
- U.S. Centers for Disease Control and Prevention Eswatini, Mbabane, Eswatini
| | | | - Yen T. Duong
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Hetal Patel
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Suzue Saito
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Chelsea Solmo
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Kristin Brown
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Chiara S. Moore
- PHI/CDC Global Health Fellowship Program, Oakland, CA, United States of America
| | - Andrew C. Voetsch
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - George Bicego
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Naomi Bock
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | | | - Tengetile Dlamini
- National Emergency Response Council on HIV/AIDS (NERCHA), Mbabane, Eswatini
| | - Khanya Mabuza
- National Emergency Response Council on HIV/AIDS (NERCHA), Mbabane, Eswatini
| | - Amos Zwane
- Central Statistics Office, Mbabane, Eswatini
| | - Ruben Sahabo
- ICAP at Columbia University, Mailman School of Public Health, Mbabane, Eswatini
| | - Trudy Dobbs
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Bharat S. Parekh
- U.S. Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, Georgia, United States of America
| | - Wafaa El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
| | - Caroline Ryan
- U.S. Centers for Disease Control and Prevention Eswatini, Mbabane, Eswatini
| | - Jessica Justman
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States of America
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, United States of America
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11
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Fraser H, Stone J, Wisse E, Sambu V, Mfisi P, Duran IJ, Soriano MA, Walker JG, Makere N, Luhmann N, Kafura W, Nouvellet M, Ragi A, Mundia B, Vickerman P. Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania. J Int AIDS Soc 2021; 24:e25817. [PMID: 34661964 PMCID: PMC8522890 DOI: 10.1002/jia2.25817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti‐retroviral therapy (ART) are available in Tanzania, their coverage is sub‐optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam. Methods An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006–2018 on HIV (∼30% and ∼67% prevalence in males and females in 2011) and HCV prevalence (∼16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766–1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling‐up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed “full HR”) and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV‐treating 10% of PWID infected with HCV annually. Results The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections among male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9–24.7%) of HIV infections and 21.7% (17.0–25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019–2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV‐treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Conclusions Combination interventions, including sexual risk reduction and HCV treatment, are needed to eliminate HCV and HIV among PWID in Tanzania.
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Affiliation(s)
- Hannah Fraser
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Stone
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Veryeh Sambu
- National AIDS Control Programmes, Dar es Salaam, Tanzania
| | - Peter Mfisi
- The Drug Control and Enforcement Authority, Prime Ministers Office, Dar es Salaam, Tanzania
| | | | | | - Josephine G Walker
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nobelrich Makere
- Tanzania Council for Social Development (TACOSODE), Dar es Salaam, Tanzania
| | | | - William Kafura
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Allan Ragi
- Kenya AIDS NGO Consortium, Nairobi, Kenya
| | | | - Peter Vickerman
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
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12
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Adawiyah RA, Saweri OPM, Boettiger DC, Applegate TL, Probandari A, Guy R, Guinness L, Wiseman V. The costs of scaling up HIV and syphilis testing in low- and middle-income countries: a systematic review. Health Policy Plan 2021; 36:939-954. [PMID: 33693731 PMCID: PMC8227996 DOI: 10.1093/heapol/czab030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 12/18/2022] Open
Abstract
Around two-thirds of all new HIV infections and 90% of syphilis cases occur in low- and middle-income countries (LMICs). Testing is a key strategy for the prevention and treatment of HIV and syphilis. Decision-makers in LMICs face considerable uncertainties about the costs of scaling up HIV and syphilis testing. This paper synthesizes economic evidence on the costs of scaling up HIV and syphilis testing interventions in LMICs and evidence on how costs change with the scale of delivery. We systematically searched multiple databases (Medline, Econlit, Embase, EMCARE, CINAHL, Global Health and the NHS Economic Evaluation Database) for peer-reviewed studies examining the costs of scaling up HIV and syphilis testing in LMICs. Thirty-five eligible studies were identified from 4869 unique citations. Most studies were conducted in Sub-Saharan Africa (N = 17) and most explored the costs of rapid HIV in facilities targeted the general population (N = 19). Only two studies focused on syphilis testing. Seventeen studies were cost analyses, 17 were cost-effectiveness analyses and 1 was cost-benefit analysis of HIV or syphilis testing. Most studies took a modelling approach (N = 25) and assumed costs increased linearly with scale. Ten studies examined cost efficiencies associated with scale, most reporting short-run economies of scale. Important drivers of the costs of scaling up included testing uptake and the price of test kits. The 'true' cost of scaling up testing is likely to be masked by the use of short-term decision frameworks, linear unit-cost projections (i.e. multiplying an average cost by a factor reflecting activity at a larger scale) and availability of health system capacity and infrastructure to supervise and support scale up. Cost data need to be routinely collected alongside other monitoring indicators as HIV and syphilis testing continues to be scaled up in LMICs.
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Affiliation(s)
- Rabiah Al Adawiyah
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Olga P M Saweri
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,Population Health and Demography, Papua New Guinea Institute of Medical Research, PO Box 60 Homate Street, Goroka, Papua New Guinea
| | - David C Boettiger
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Tanya L Applegate
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A. Surakarta, 57126, Indonesia
| | - Rebecca Guy
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.,Centre for Global DevelopmentEurope, Great Peter House, Great College St, London SW1P 3SE, UK
| | - Virginia Wiseman
- The Kirby Institute, University New South Wales, High St, Kensington 2052, New South Wales, Australia.,London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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13
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Comparison of two simulators for individual based models in HIV epidemiology in a population with HSV 2 in Yaoundé (Cameroon). Sci Rep 2021; 11:14696. [PMID: 34282252 PMCID: PMC8289823 DOI: 10.1038/s41598-021-94289-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Model comparisons have been widely used to guide intervention strategies to control infectious diseases. Agreement between different models is crucial for providing robust evidence for policy-makers because differences in model properties can influence their predictions. In this study, we compared models implemented by two individual-based model simulators for HIV epidemiology in a heterosexual population with Herpes simplex virus type-2 (HSV-2). For each model simulator, we constructed four models, starting from a simplified basic model and stepwise including more model complexity. For the resulting eight models, the predictions of the impact of behavioural interventions on the HIV epidemic in Yaoundé-Cameroon were compared. The results show that differences in model assumptions and model complexity can influence the size of the predicted impact of the intervention, as well as the predicted qualitative behaviour of the HIV epidemic after the intervention. These differences in predictions of an intervention were also observed for two models that agreed in their predictions of the HIV epidemic in the absence of that intervention. Without additional data, it is impossible to determine which of these two models is the most reliable. These findings highlight the importance of making more data available for the calibration and validation of epidemiological models.
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14
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Nguyen PT, Gilmour S, Le PM, Onishi K, Kato K, Nguyen HV. Progress toward HIV elimination goals: trends in and projections of annual HIV testing and condom use in Africa. AIDS 2021; 35:1253-1262. [PMID: 33730746 DOI: 10.1097/qad.0000000000002870] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To estimate trends in and projections of annual HIV testing and condom use at last higher-risk sex and to calculate the probability of reaching key United Nations Programme on AIDS (UNAIDS)'s target. DESIGN We included 114 nationally-representative datasets in 38 African countries from Demographic and Health Surveys and Multiple Indicator Cluster Surveys with 1 456 224 sexually active adults age 15-49 from 2003 to 2018. METHODS We applied Bayesian mixed effect models to estimate the coverage of annual HIV testing and condom use at last higher-risk sex for every country and year to 2030 and the probability of reaching UNAIDS testing and condom use targets of 95% coverage by 2030. RESULTS Seven countries saw downward trends in annual HIV testing and four saw decreases in condom use at higher-risk sex, whereas most countries have upward trends in both indicators. The highest coverage of testing in 2030 is predicted in Swaziland with 92.6% (95% credible interval: 74.5-98.1%), Uganda with 90.5% (72.2-97.2%), and Lesotho with 90.5% (69.4%-97.6%). Meanwhile, Swaziland, Lesotho, and Namibia will have the highest proportion of condom use in 2030 at 85.0% (57.8-96.1%), 75.6% (42.3-93.6%), and 75.5% (42.4-93.2%). The probabilities of reaching targets were very low for both HIV testing (0-28.5%) and condom use (0-12.1%). CONCLUSIONS We observed limited progress on annual HIV testing and condom use at last higher-risk sex in Africa and little prospect of reaching global targets for HIV/AIDS elimination. Although some funding agencies are considering withdrawal from supporting Africa, more attention to funding and expanding testing and treatment is needed in this region.
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Affiliation(s)
- Phuong T Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo
| | - Phuong M Le
- Graduate School of Public Health, St. Luke's International University, Tokyo
| | - Kazunari Onishi
- Graduate School of Public Health, St. Luke's International University, Tokyo
| | - Kosuke Kato
- Department of Obstetrics and Gynaecology, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Huy V Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo
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15
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Partnership dynamics in mathematical models and implications for representation of sexually transmitted infections: a review. Ann Epidemiol 2021; 59:72-80. [PMID: 33930528 DOI: 10.1016/j.annepidem.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/05/2021] [Accepted: 04/18/2021] [Indexed: 11/20/2022]
Abstract
Mathematical models of sexually transmitted disease (STI) are increasingly relied on to inform policy, practice, and resource allocation. Because STI transmission requires sexual contact between two or more people, a model's ability to represent the dynamics of sexual partnerships can influence the validity of findings. This ability is to a large extent constrained by the model type, as different modeling frameworks vary in their capability to capture patterns of sexual contact at individual, partnership, and network levels. In this paper, we classify models into three groups: compartmental, individual-based, and statistical network models. For each framework, we describe the basic model structure and discuss key aspects of sexual partnership dynamics: how and with whom partnerships are formed, partnership duration and dissolution, and temporal overlap in partnerships (concurrency). We illustrate the potential implications of accurately accounting for partnership dynamics, but these effects depend on characteristics of both the population and pathogen; the combined impact of these partnership and epidemiologic dynamics can be difficult to predict. While each of the reviewed model frameworks may be appropriate to inform certain research or policy questions, modelers and consumers of models should carefully consider the implications of sexual partnership dynamics for the questions under study.
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16
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Naslazi E, Hontelez JAC, Naber SK, van Ballegooijen M, de Kok IMCM. The Differential Risk of Cervical Cancer in HPV-Vaccinated and -Unvaccinated Women: A Mathematical Modeling Study. Cancer Epidemiol Biomarkers Prev 2021; 30:912-919. [PMID: 33837119 DOI: 10.1158/1055-9965.epi-20-1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/15/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND With increased uptake of vaccination against human papillomavirus (HPV), protection against cervical cancer will also increase for unvaccinated women, due to herd immunity. Still, the differential risk between vaccinated and unvaccinated women might warrant a vaccination-status-screening approach. To understand the potential value of stratified screening protocols, we estimated the risk differentials in HPV and cervical cancer between vaccinated and unvaccinated women. METHODS We used STDSIM, an individual-based model of HPV transmission and control, to estimate the HPV prevalence reduction over time, after introduction of HPV vaccination. We simulated scenarios of bivalent or nonavalent vaccination in females-only or females and males, at 20% coverage increments. We estimated relative HPV-type-specific prevalence reduction compared with a no-vaccination counterfactual and then estimated the age-specific cervical cancer risk by vaccination status. RESULTS The relative cervical cancer risk for unvaccinated compared with vaccinated women ranged from 1.7 (bivalent vaccine for females and males; 80% coverage) to 10.8 (nonavalent vaccine for females-only; 20% coverage). Under 60% vaccination coverage, which is a representative coverage for several western countries, including the United States, the relative risk (RR) varies between 2.2 (bivalent vaccine for females and males) and 9.2 (nonavalent vaccine for females). CONCLUSIONS We found large cervical cancer risk differences between vaccinated and unvaccinated women. In general, our model shows that the RR is higher in lower vaccine coverages, using the nonavalent vaccine, and when vaccinating females only. IMPACT To avoid a disbalance in harms and benefits between vaccinated and unvaccinated women, vaccination-based screening needs serious consideration.
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Affiliation(s)
- Emi Naslazi
- Erasmus Medical Center-University Medical Center, Department of Public Health, Rotterdam, the Netherlands.
| | - Jan A C Hontelez
- Erasmus Medical Center-University Medical Center, Department of Public Health, Rotterdam, the Netherlands.,Heidelberg Institute of Global Health, Heidelberg, Germany
| | - Steffie K Naber
- Erasmus Medical Center-University Medical Center, Department of Public Health, Rotterdam, the Netherlands
| | - Marjolein van Ballegooijen
- Erasmus Medical Center-University Medical Center, Department of Public Health, Rotterdam, the Netherlands
| | - Inge M C M de Kok
- Erasmus Medical Center-University Medical Center, Department of Public Health, Rotterdam, the Netherlands
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Stansfield SE, Herbeck JT, Gottlieb GS, Abernethy NF, Murphy JT, Mittler JE, Goodreau SM. Test-and-treat coverage and HIV virulence evolution among men who have sex with men. Virus Evol 2021; 7:veab011. [PMID: 33633867 PMCID: PMC7893213 DOI: 10.1093/ve/veab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV set point viral load (SPVL), the viral load established shortly after initial infection, is a proxy for HIV virulence: higher SPVLs lead to higher risk of transmission and faster disease progression. Three models of test-and-treat scenarios, mainly in heterosexual populations, found that increasing treatment coverage selected for more virulent viruses. We modeled virulence evolution in a population of men who have sex with men (MSM) with increasing test-and-treat coverage. We extended a stochastic, dynamic network model (EvoNetHIV). We varied relationship patterns (MSM vs. heterosexual), HIV transmission models (increasing vs. plateauing probability of transmission at very high viral loads), and treatment roll-out (with explicit testing or fixed intervals between infection and treatment). In scenarios most similar to previous models (longer relational durations and the plateauing transmission function), we replicated trends previously found: increasing treatment coverage led to increased virulence (0.12 log10 increase in mean population SPVL between 20% and 100% treatment coverage). In scenarios reflecting MSM behavioral data using the increasing transmission function, increasing treatment coverage selected for viruses with lower virulence (0.16 log10 decrease in mean population SPVL between 20% and 100% treatment coverage). These findings emphasize the impact of sexual network conditions and transmission function details on predicted epidemiological and evolutionary outcomes. Varying these features creates very different evolutionary environments, which in turn lead to opposite effects in mean population SPVL evolution. Our results suggest that, under some realistic conditions, effective test-and-treat strategies may not face the previously reported tradeoff in which increasing coverage leads to evolution of greater virulence. This suggests instead that a virtuous cycle of increasing treatment coverage and diminishing virulence is possible.
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Affiliation(s)
- Sarah E Stansfield
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - Joshua T Herbeck
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Geoffrey S Gottlieb
- Departments of Medicine & Global Health, University of Washington, Seattle, WA 98195, USA
| | - Neil F Abernethy
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
| | - James T Murphy
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - John E Mittler
- Department of Microbiology, University of Washington, Seattle, WA 98195, USA
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, WA 98195, USA
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18
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Chauke P, Huma M, Madiba S. Lost to follow up rate in the first year of ART in adults initiated in a universal test and treat programme: a retrospective cohort study in Ekurhuleni District, South Africa. Pan Afr Med J 2020; 37:198. [PMID: 33505567 PMCID: PMC7813655 DOI: 10.11604/pamj.2020.37.198.25294] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/26/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction South Africa adopted and implemented the Universal Test and Treat (UTT) strategy for HIV since 2016. However, the care outcomes for patients initiated antiretroviral therapy (ART) through the UTT strategy have not been established. We determined the rate of lost to follow up (LTFU) and associated factors in patients who were initiated on ART through the UTT and the pre-ART strategy at 12 months post ART initiation. Methods this retrospective study analyzed the records of a cohort of patients at 12 months post the initiation of ART. We extracted data from the TIER.Net electronic database of selected facilities in a sub-district in Gauteng Province, South Africa. Factors associated with LFTU at 12 months of ART were assessed and logistic regression performed to identify predictors of LFTU. Results records of 367 patients were evaluated, and 54% were initiated ART through the UTT strategy. The mean age was 36.3 years, mean CD4 cell count at ART initiation was 341 cells/mm3, and 25% were initiated at CD4 cell count above 500 cells/mm3. LTFU at 12 months was 28%, 50% were LFTU within six months, and 28% within three months of ART. LFTU in the UTT cohort was higher than in the pre-ART cohort, patients initiated through UTT were twice more likely to be LTFU (AOR = 1.84, CI: 1.13-3.00) than pre-ART patients. Conclusion the rate of LTFU at 12 months of ART was 28%, which indicate that the retention in care rate (60%) falls far short of the triple 90 targets required for viral suppression.
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Affiliation(s)
- Patricia Chauke
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mmampedi Huma
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sphiwe Madiba
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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19
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Green D, Tordoff DM, Kharono B, Akullian A, Bershteyn A, Morrison M, Garnett G, Duerr A, Drain PK. Evidence of sociodemographic heterogeneity across the HIV treatment cascade and progress towards 90-90-90 in sub-Saharan Africa - a systematic review and meta-analysis. J Int AIDS Soc 2020; 23:e25470. [PMID: 32153117 PMCID: PMC7062634 DOI: 10.1002/jia2.25470] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Heterogeneity of sociodemographics and risk behaviours across the HIV treatment cascade could influence the public health impact of universal ART in sub‐Saharan Africa if those not virologically suppressed are more likely to be part of a risk group contributing to onward infections. Sociodemographic and risk heterogeneity across the treatment cascade has not yet been comprehensively described or quantified and we seek to systematically review and synthesize research on this topic among adults in Africa. Methods We conducted a systematic review of peer‐reviewed literature in Embase and MEDLINE databases as well as grey literature sources published in English between 2014 and 2018. We included studies that included people living with HIV (PLHIV) aged ≥15 years, and reported a 90‐90‐90 outcome: awareness of HIV‐positive status, ART use among those diagnosed or viral suppression among those on ART. We summarized measures of association between sociodemographics, within each outcome, and as a composite measure of population‐wide viral suppression. Results and discussion From 3533 screened titles, we extracted data from 92 studies (50 peer‐reviewed, 42 grey sources). Of included studies, 32 reported on awareness, 53 on ART use, 32 on viral suppression and 23 on population‐wide viral suppression. The majority of studies were conducted in South Africa, Uganda, and Malawi and reported data for age and gender. When stratified, PLHIV ages 15 to 24 years had lower median achievement of the treatment cascade (60‐49‐81), as compared to PLHIV ≥25 years (70‐63‐91). Men also had lower median achievement of the treatment cascade (66‐72‐85), compared to women (79‐76‐89). For population‐wide viral suppression, women aged ≥45 years had achieved the 73% target, while the lowest medians were among 15‐ to 24‐year‐old men (37%) and women (49%). Conclusions Considerable heterogeneity exists by age and gender for achieving the HIV 90‐90‐90 treatment goals. These results may inform delivery of HIV testing and treatment in sub‐Saharan Africa, as targeting youth and men could be a strategic way to maximize the population‐level impact of ART.
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Affiliation(s)
- Dylan Green
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA
| | - Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA
| | - Brenda Kharono
- Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Adam Akullian
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Institute for Disease Modeling (IDM), Bellevue, WA, USA
| | | | | | | | - Ann Duerr
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA.,Vaccine and Infectious Disease, Public Health Science Divisions, Fred Hutchinson Cancer Resesarch Center, HIV Vaccine Trials Network, Seattle, WA, USA
| | - Paul K Drain
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Strategic Analysis, Research & Training (START) Center, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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20
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Kakisingi C, Muteba M, Mukuku O, Kyabu V, Ngwej K, Kajimb P, Manika M, Situakibanza H, Mwamba C, Ngwej D. Prevalence and characteristics of HIV infection among female sex workers in Lubumbashi, Democratic Republic of Congo. Pan Afr Med J 2020; 36:280. [PMID: 33088409 PMCID: PMC7545968 DOI: 10.11604/pamj.2020.36.280.21378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 07/13/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction female sex workers (FSWs) are considered a high-risk group for acquiring HIV infection due to their HIV prevalence estimated to be 10-20 times higher than in woman in the general population. This study aimed to determine the prevalence and risk factors of HIV among female sex workers (FSWs) in Lubumbashi. Methods a cross-sectional study was conducted among FSWs presenting for the first time at the sexually transmitted infections (STIs) clinic of Katuba, Lubumbashi, between April 2016 and December 2017. Information on the participants´ socio-demographic characteristics, sexual behaviors, and HIV serology results were collated and analyzed using a multiple logistic regression to identify factors associated to HIV infection among FSWs. Results information on 1555 sex workers was analysed in this study, the prevalence of HIV was 8.2%. The median age of the participants was 26 years (IQR: 21-34). Of the 127 HIV positive sex workers, 74% have been in the business for two years or less, 97% sell sex as their main income, 74% have more than 5 sexual intercourses per week, 95% reported using condom, 73% reported having history of STIs, 70% reported using alcohol before sex and 97% reported having three or more sexual partners per week. After adjusting for potentials cofounders, Age, Sex work as main income, years of selling sex, condom use, and alcohol use before sex were found to have a significant effect on HIV infection among sex workers. Conclusion these findings highlight the vulnerability of FSWs to HIV infection and the necessity of immediate interventions to strengthen HIV prevention through behavioral change strategies and making available Pre-exposure Prophylaxis (PrEP) for FSWs in Lubumbashi.
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Affiliation(s)
- Christian Kakisingi
- Department of Internal Medicine, School of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,Medical District of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michel Muteba
- Division of epidemiology and biostatistics, School of Public Health, University of Witwatersrand, Johannesburg, Republic of South Africa
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales de Lubumbashi, Lubumbashi, République démocratique du Congo
| | - Véronique Kyabu
- Department of Internal Medicine, School of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,Sexually Transmitted Infectious Clinic of Katuba, Lubumbashi, Republic Democratic of the Congo
| | - Kevin Ngwej
- Sexually Transmitted Infectious Clinic of Katuba, Lubumbashi, Republic Democratic of the Congo
| | - Patricia Kajimb
- Medical District of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michel Manika
- Department of Internal Medicine, School of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Hippolyte Situakibanza
- Department of Internal Medicine, Department of Tropical Diseases and of Infectious and Parasitological Diseases, School of Medicine, University of Kinshasa, Kinshasa, Republic Democratic of the Congo
| | - Claude Mwamba
- Department of Internal Medicine, School of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Dieudonné Ngwej
- Department of Pediatric, School of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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21
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Wong NS, Lee MP, Wong KH, Tsang OTY, Lee SS. The differential impacts of non-locally acquired infections and treatment interventions on heterosexual HIV transmission in Hong Kong. PLoS One 2020; 15:e0237433. [PMID: 32790778 PMCID: PMC7425942 DOI: 10.1371/journal.pone.0237433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Heterosexual infections have contributed to a high proportion of the HIV burden in Asia and Eastern Europe. Human mobility and non-local infections are important features in some cities/countries. An understanding of the determinants of the sustained growth of the heterosexual HIV epidemics would enable the potential impacts of treatment-based interventions to be assessed. Methods We developed a compartmental model for heterosexual HIV transmissions, parameterized by clinical and surveillance data (1984–2014) in Hong Kong. HIV sequence data were included for examining genetic linkages and clustering pattern. We performed sensitivity analyses to evaluate effects of high-risk sexual partnership and proportions of non-locally acquired infections. Four hypothetical interventions (a) immediate treatment, (b) enhancement of retention in care, (c) HIV testing campaigns, and (d) test-and-treat strategy, were examined. Results Data of 2174 patients (723 female and 1451 male) diagnosed with HIV between 1984 and 2012 in Hong Kong were collected for model parameterization. Among 1229 sequences of non-MSM (men who have sex with men) patients, 70% were isolates and 17% were either dyads or triads. In base-case scenario, the total estimated number of new infections in 2012–2023 would be 672 for male and 452 for female. Following 100% retention in care intervention, the total proportion of averted new infections in 2012–2023 would be 7% for male and 10% for female. HIV testing campaign in 2012 and 2017 followed by 100% immediate treatment strategy would avert 5% and 9% of male and female new infections, respectively. In the epidemic model, an increase of high-risk sexual partnership from 6% to 9% would increase the epidemic growth (annual number of newly diagnosed and newly infected cases) by about 10%. If no non-locally acquired infection occurred as from 2012, the epidemic growth would slump. To control the heterosexual epidemic, periodic HIV testing at 5-year intervals with immediate treatment would avert 5–13% of annual new infections in 2013–2023. Conclusions Enhanced HIV testing with immediate treatment is most effective in controlling the heterosexual epidemic, the impacts of which might however be attenuated by any increase of non-locally acquired infection, assuming little variations of high risk partnership over time.
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Affiliation(s)
- Ngai Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, People’s Republic of China
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Man Po Lee
- Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong, People’s Republic of China
| | - Ka Hing Wong
- Special Preventive Programme, Department of Health, Hong Kong Special Administrative Region Government, Hong Kong, People’s Republic of China
| | - Owen T. Y. Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Lai King, Kowloon, Hong Kong, People’s Republic of China
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, People’s Republic of China
- * E-mail:
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22
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Knight J, Baral SD, Schwartz S, Wang L, Ma H, Young K, Hausler H, Mishra S. Contribution of high risk groups' unmet needs may be underestimated in epidemic models without risk turnover: A mechanistic modelling analysis. Infect Dis Model 2020; 5:549-562. [PMID: 32913937 PMCID: PMC7452422 DOI: 10.1016/j.idm.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Epidemic models of sexually transmitted infections (STIs) are often used to characterize the contribution of risk groups to overall transmission by projecting the transmission population attributable fraction (tPAF) of unmet prevention and treatment needs within risk groups. However, evidence suggests that STI risk is dynamic over an individual’s sexual life course, which manifests as turnover between risk groups. We sought to examine the mechanisms by which turnover influences modelled projections of the tPAF of high risk groups. Methods We developed a unifying, data-guided framework to simulate risk group turnover in deterministic, compartmental transmission models. We applied the framework to an illustrative model of an STI and examined the mechanisms by which risk group turnover influenced equilibrium prevalence across risk groups. We then fit a model with and without turnover to the same risk-stratified STI prevalence targets and compared the inferred level of risk heterogeneity and tPAF of the highest risk group projected by the two models. Results The influence of turnover on group-specific prevalence was mediated by three main phenomena: movement of previously high risk individuals with the infection into lower risk groups; changes to herd effect in the highest risk group; and changes in the number of partnerships where transmission can occur. Faster turnover led to a smaller ratio of STI prevalence between the highest and lowest risk groups. Compared to the fitted model without turnover, the fitted model with turnover inferred greater risk heterogeneity and consistently projected a larger tPAF of the highest risk group over time. Implications If turnover is not captured in epidemic models, the projected contribution of high risk groups, and thus, the potential impact of prioritizing interventions to address their needs, could be underestimated. To aid the next generation of tPAF models, data collection efforts to parameterize risk group turnover should be prioritized. A new framework for parameterizing turnover in risk groups is developed. Mechanisms by which turnover influences sexually transmitted infection (STI), prevalence in risk groups are examined. Turnover reduces the ratio of equilibrium STI prevalence in high vs low risk groups. Inferred risk heterogeneity is higher when fitting transmission models with turnover. Ignoring turnover in risk could underestimate the transmission population attributable fraction (tPAF), of high risk groups to the overall epidemic.
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Affiliation(s)
- Jesse Knight
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada
| | - Stefan D Baral
- Deptartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Sheree Schwartz
- Deptartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Linwei Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada
| | - Huiting Ma
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada
| | | | | | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Canada.,Division of Infectious Disease, Department of Medicine, University of Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Canada
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23
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The past, present and future impact of HIV prevention and control on HPV and cervical disease in Tanzania: A modelling study. PLoS One 2020; 15:e0231388. [PMID: 32374729 PMCID: PMC7202618 DOI: 10.1371/journal.pone.0231388] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background Women with HIV have an elevated risk of HPV infection, and eventually, cervical cancer. Tanzania has a high burden of both HIV and cervical cancer, with an HIV prevalence of 5.5% in women in 2018, and a cervical cancer incidence rate among the highest globally, at 59.1 per 100,000 per year, and an estimated 9,772 cervical cancers diagnosed in 2018. We aimed to quantify the impact that interventions intended to control HIV have had and will have on cervical cancer in Tanzania over a period from 1995 to 2070. Methods A deterministic transmission-dynamic compartment model of HIV and HPV infection and natural history was used to simulate the impact of voluntary medical male circumcision (VMMC), anti-retroviral therapy (ART), and targeted pre-exposure prophylaxis (PrEP) on cervical cancer incidence and mortality from 1995–2070. Findings We estimate that VMMC has prevented 2,843 cervical cancer cases and 1,039 cervical cancer deaths from 1995–2020; by 2070 we predict that VMMC will have lowered cervical cancer incidence and mortality rates by 28% (55.11 cases per 100,000 women in 2070 without VMMC, compared to 39.93 with VMMC only) and 26% (37.31 deaths per 100,000 women in 2070 without VMMC compared to 27.72 with VMMC), respectively. We predict that ART will temporarily increase cervical cancer diagnoses and deaths, due to the removal of HIV death as a competing risk, but will ultimately further lower cervical cancer incidence and mortality rates by 7% (to 37.31 cases per 100,000 women in 2070) and 5% (to 26.44 deaths per 100,000 women in 2070), respectively, relative to a scenario with VMMC but no ART. A combination of ART and targeted PrEP use is anticipated to lower cervical cancer incidence and mortality rates to 35.82 and 25.35 cases and deaths, respectively, per 100,000 women in 2070. Conclusions HIV treatment and control measures in Tanzania will result in long-term reductions in cervical cancer incidence and mortality. Although, in the near term, the life-extending capability of ART will result in a temporary increase in cervical cancer rates, continued efforts towards HIV prevention will reduce cervical cancer incidence and mortality over the longer term. These findings are critical background to understanding the longer-term impact of achieving cervical cancer elimination targets in Tanzania.
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24
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Baggaley RF, Hollingsworth TD. How universal does universal test and treat have to be? Lancet HIV 2020; 7:e306-e308. [PMID: 32061316 DOI: 10.1016/s2352-3018(20)30031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Rebecca F Baggaley
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK.
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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25
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Akullian A, Morrison M, Garnett GP, Mnisi Z, Lukhele N, Bridenbecker D, Bershteyn A. The effect of 90-90-90 on HIV-1 incidence and mortality in eSwatini: a mathematical modelling study. Lancet HIV 2020; 7:e348-e358. [PMID: 32061317 PMCID: PMC7221345 DOI: 10.1016/s2352-3018(19)30436-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 12/26/2022]
Abstract
Background The rapid scale-up of antiretroviral therapy (ART) towards the UNAIDS 90-90-90 goals over the last decade has sparked considerable debate as to whether universal test and treat can end the HIV-1 epidemic in sub-Saharan Africa. We aimed to develop a network transmission model, calibrated to capture age-specific and sex-specific gaps in the scale-up of ART, to estimate the historical and future effect of attaining and surpassing the UNAIDS 90-90-90 treatment targets on HIV-1 incidence and mortality, and to assess whether these interventions will be enough to achieve epidemic control (incidence of 1 infection per 1000 person-years) by 2030. Methods We used eSwatini (formerly Swaziland) as a case study to develop our model. We used data on HIV prevalence by 5-year age bins, sex, and year from the 2007 Swaziland Demographic Health Survey (SDHS), the 2011 Swaziland HIV Incidence Measurement Survey, and the 2016 Swaziland Population Health Impact Assessment (PHIA) survey. We estimated the point prevalence of ART coverage among all HIV-infected individuals by age, sex, and year. Age-specific data on the prevalence of male circumcision from the SDHS and PHIA surveys were used as model inputs for traditional male circumcision and scale-up of voluntary medical male circumcision (VMMC). We calibrated our model using publicly available data on demographics; HIV prevalence by 5-year age bins, sex, and year; and ART coverage by age, sex, and year. We modelled the effects of five scenarios (historical scale-up of ART and VMMC [status quo], no ART or VMMC, no ART, age-targeted 90-90-90, and 100% ART initiation) to quantify the contribution of ART scale-up to declines in HIV incidence and mortality in individuals aged 15–49 by 2016, 2030, and 2050. Findings Between 2010 and 2016, status-quo ART scale-up among adults (aged 15–49 years) in eSwatini (from 34·0% in 2010 to 74·1% in 2016) reduced HIV incidence by 43·57% (95% credible interval 39·71 to 46·36) and HIV mortality by 56·17% (54·06 to 58·92) among individuals aged 15–49 years, with larger reductions in incidence among men and mortality among women. Holding 2016 ART coverage levels by age and sex into the future, by 2030 adult HIV incidence would fall to 1·09 (0·87 to 1·29) per 100 person-years, 1·42 (1·13 to 1·71) per 100 person-years among women and 0·79 (0·63 to 0·94) per 100 person-years among men. Achieving the 90-90-90 targets evenly by age and sex would further reduce incidence beyond status-quo ART, primarily among individuals aged 15–24 years (an additional 17·37% [7·33 to 26·12] reduction between 2016 and 2030), with only modest additional incidence reductions in adults aged 35–49 years (1·99% [–5·09 to 7·74]). Achieving 100% ART initiation among all people living with HIV within an average of 6 months from infection—an upper bound of plausible treatment effect—would reduce adult HIV incidence to 0·73 infections (0·55 to 0·92) per 100 person-years by 2030 and 0·46 (0·33 to 0·59) per 100 person-years by 2050. Interpretation Scale-up of ART over the last decade has already contributed to substantial reductions in HIV-1 incidence and mortality in eSwatini. Focused ART targeting would further reduce incidence, especially in younger individuals, but even the most aggressive treatment campaigns would be insufficient to end the epidemic in high-burden settings without a renewed focus on expanding preventive measures. Funding Global Good Fund and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Adam Akullian
- Institute for Disease Modeling, Bellevue, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
| | | | | | - Zandile Mnisi
- Ministry of Health, Kingdom of eSwatini, Mbabane, eSwatini
| | | | | | - Anna Bershteyn
- Institute for Disease Modeling, Bellevue, WA, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA
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Abstract
OBJECTIVES Immediate ART (or early access to ART for all, EAAA) is becoming a national policy in many countries in sub-Saharan Africa. It is plausible that the switch from delayed to immediate ART could either increase or decrease patient satisfaction with treatment. A decrease in patient satisfaction would likely have detrimental consequences for long-term retention and adherence, in addition to the value lost because of the worsening patient experience itself. We conducted a pragmatic stepped-wedge cluster-randomized controlled trial (SW-cRCT) to determine the causal impact of immediate treatment for HIV on patient satisfaction. DESIGN This seven-step SW-cRCT took place in 14 public-sector health facilities in Eswatini's Hhohho region, from September 2014 to August 2017. METHODS During each step of the trial, we randomly selected days for data collection at each study facility. During these days, a random sample of HIV patients were selected for outcome assessment. In total, 2629 patients provided data on their overall patient satisfaction and satisfaction with the following four domains of the patient experience using a five-point Likert scale: wait time, consultation time, involvement in treatment decisions, and respectful treatment. Higher values on the Likert scale indicated lower patient satisfaction. We analyzed the data using a multilevel ordered logistic regression model with individuals at the first level and health facilities at the second (cluster) level. RESULTS The proportional odds ratio (OR) comparing EAAA to control was 0.91 (95% CI 0.66-1.25) for overall patient satisfaction. For the specific domains of the patient experience, the ORs describing the impact of EAAA on satisfaction were 1.04 (95% CI 0.61-1.78) for wait time, 0.90 (95% CI 0.62-1.31) for involvement in treatment decisions, 0.86 (95% CI 0.61-1.20) for consultation time, and 1.35 (95% CI 0.93-1.96) for respectful treatment. These results were robust across a wide range of sensitivity analyses. Over time - and independent of EAAA - we observed a worsening trend for both overall patient satisfaction and satisfaction in the four domains of the patient experience we measured. CONCLUSION Our findings support the policy change from delayed to immediate ART in sub-Saharan Africa. Immediate (versus delayed) ART in public-sector health facilities in Eswatini had no effect on either overall patient satisfaction or satisfaction with four specific domains of the patient experience. At the same time, we observed a strong secular trend of decreasing patient satisfaction in both the intervention and the control arm of the trial. Further implementation research should identify approaches to ensure high patient satisfaction as ART programs grow and mature.
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27
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Baral S, Rao A, Sullivan P, Phaswana-Mafuya N, Diouf D, Millett G, Musyoki H, Geng E, Mishra S. The disconnect between individual-level and population-level HIV prevention benefits of antiretroviral treatment. Lancet HIV 2019; 6:e632-e638. [PMID: 31331822 DOI: 10.1016/s2352-3018(19)30226-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 01/14/2023]
Abstract
In 2019, the HIV pandemic is growing and soon over 40 million people will be living with HIV. Effective population-based approaches to decrease HIV incidence are as relevant as ever given modest reductions observed over the past decade. Treatment as prevention is often heralded as the path to improve HIV outcomes and to reduce HIV incidence. Although treatment of an individual does eliminate onward transmission to serodifferent partners (undetectable=untransmittable or U=U), population-level observational and experimental data have not shown a similar effect with scale-up of treatment on reducing HIV incidence. This disconnect might be the result of little attention given to heterogeneities of HIV acquisition and transmission risks that exist in people at risk for and living with HIV, even in the most broadly generalised epidemics. Available data suggest that HIV treatment is treatment, HIV prevention is prevention, and specificity of HIV treatment approaches towards people at highest risk of onward transmission drives the intersection between the two. All people living with HIV deserve HIV treatment, but both more accurately estimating and optimising the potential HIV prevention effects of universal treatment approaches necessitates understanding who is being supported with treatment rather than a focus on treatment targets such as 90-90-90 or 95-95-95.
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Affiliation(s)
- Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Amrita Rao
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Patrick Sullivan
- Department of Epidemiology, Laney Graduate School, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Greg Millett
- amfAR, the Foundation for AIDS Research, Washington, DC, USA
| | - Helgar Musyoki
- National AIDS and Sexually Transmitted Infection Control Programme, Ministry of Health, Nairobi, Kenya
| | - Elvin Geng
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sharmistha Mishra
- St Michael's Hospital, Li Ka Shing Knowledge Institute, and Department of Medicine, Division of Infectious Disease, University of Toronto, Toronto, Canada
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Osetinsky B, Hontelez JAC, Lurie MN, McGarvey ST, Bloomfield GS, Pastakia SD, Wamai R, Bärnighausen T, de Vlas SJ, Galárraga O. Epidemiological And Health Systems Implications Of Evolving HIV And Hypertension In South Africa And Kenya. Health Aff (Millwood) 2019; 38:1173-1181. [PMID: 31260360 PMCID: PMC7983613 DOI: 10.1377/hlthaff.2018.05287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health systems in sub-Saharan Africa are facing an ongoing HIV epidemic and increasing burden of noncommunicable disease. With the focus shifting to the development of comprehensive primary health care and chronic disease treatment, multidisease modeling is integral to estimating future health care needs. We extended an established agent-based model of HIV transmission to include hypertension in two rural settings: KwaZulu-Natal, South Africa, and western Kenya. We estimated that from 2018 to 2028 hypertension prevalence would increase from 40 percent to 46 percent in KwaZulu-Natal and from 29 percent to 35 percent in western Kenya, while HIV prevalence is stabilizing and predicted to decrease. As the health system burden in sub-Saharan Africa is changing, innovative chronic disease treatment and the broadening of successful programs, such as integrated HIV and noncommunicable disease care, are necessary to reach universal health care coverage.
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Affiliation(s)
- Brianna Osetinsky
- Brianna Osetinsky is a PhD candidate in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, in Providence, Rhode Island
| | - Jan A C Hontelez
- Jan A. C. Hontelez is an assistant professor in the Department of Public Health at Erasmus MC, Erasmus University Rotterdam, in the Netherlands, and at the Heidelberg Institute of Global Health, Heidelberg University, in Germany
| | - Mark N Lurie
- Mark N. Lurie is an associate professor in the Department of Epidemiology, Brown University School of Public Health
| | - Stephen T McGarvey
- Stephen T. McGarvey is director of the International Health Institute and a professor in the Department of Epidemiology, both at the Brown University School of Public Health
| | - Gerald S Bloomfield
- Gerald S. Bloomfield is an associate professor in the Department of Medicine and Global Health, Duke University School of Medicine, in Durham, North Carolina
| | - Sonak D Pastakia
- Sonak D. Pastakia is a professor of pharmacy practice with the Purdue Kenya Partnership, Purdue University College of Pharmacy, in Eldoret, Kenya
| | - Richard Wamai
- Richard Wamai is an associate professor in the Department of Cultures, Societies, and Global Studies, Northeastern University, in Boston, Massachusetts
| | - Till Bärnighausen
- Till Bärnighausen is the Alexander von Humboldt University Professor and director of the Heidelberg Institute of Global Health, Heidelberg University. He is also senior faculty at the Africa Health Research Institute, in Somkhele, South Africa, and an adjunct professor of global health at the Harvard T. H. Chan School of Public Health, in Boston
| | - Sake J de Vlas
- Sake J. de Vlas is a professor in the Department of Public Health at Erasmus MC, Erasmus University Rotterdam
| | - Omar Galárraga
- Omar Galárraga ( ) is an associate professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health
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29
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Topp SM, Chetty-Makkan CM, Smith HJ, Chimoyi L, Hoffmann CJ, Fielding K, Reid SE, Olivier AJ, Hausler H, Herce ME, Charalambous S. "It's Not Like Taking Chocolates": Factors Influencing the Feasibility and Sustainability of Universal Test and Treat in Correctional Health Systems in Zambia and South Africa. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:189-202. [PMID: 31249019 PMCID: PMC6641809 DOI: 10.9745/ghsp-d-19-00051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/09/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sub-Saharan African correctional facilities concentrate large numbers of people who are living with HIV or at risk for HIV infection. Universal test and treat (UTT) is widely recognized as a promising approach to improve the health of individuals and a population health strategy to reduce new HIV infections. In this study, we explored the feasibility and sustainability of implementing UTT in correctional facilities in Zambia and South Africa. METHODS Nested within a UTT implementation research study, our qualitative evaluation of feasibility and sustainability used a case-comparison design based on data from 1 Zambian and 3 South African correctional facilities. Primary data from in-depth interviews with incarcerated individuals, correctional managers, health care providers, and policy makers were supplemented by public policy documents, study documentation, and implementation memos in both countries. Thematic analysis was informed by an empirically established conceptual framework for health system analysis. RESULTS Despite different institutional profiles, we were able to successfully introduce UTT in the South Africa and Zambian correctional facilities participating in the study. A supportive policy backdrop was important to UTT implementation and establishment in both countries. However, sustainability of UTT, defined as relevant government departments' capacity to independently plan, resource, and administer quality UTT, differed. South Africa's correctional facilities had existing systems to deliver and monitor chronic HIV care and treatment, forming a "scaffolding" for sustained UTT despite some human resources shortages and poorly integrated health information systems. Notwithstanding recent improvements, Zambia's correctional health system demonstrated insufficient material and technical capacity to independently deliver quality UTT. In the correctional facilities of both countries, inmate population dynamics and their impact on HIV-related stigma were important factors in UTT service uptake. CONCLUSION Findings demonstrate the critical role of policy directives, health service delivery systems, adequate resourcing, and population dynamics on the feasibility and likely sustainability of UTT in corrections in Zambia and South Africa.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia. .,Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | - Helene J Smith
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | | | | | | | - Stewart E Reid
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | | | | | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Hattis RP, Strydom RY, Gaio J, Stover DC. HIV Prevention Practices and Non-Federal Funding Among U.S. States and Non-State Regions: A Survey of HIV/AIDS Directors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:82-94. [PMID: 30742479 DOI: 10.1521/aeap.2019.31.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We surveyed U.S. HIV/AIDS directors or designees in states and non-state regions, regarding factors influencing HIV viral suppression: (1) non-federal prevention funding; (2) contacting newly reported patients and providers, for care linkage and partner services; (3) follow-up of non-received viral load reports, to identify untreated patients; and (4) genotype/phenotype surveillance, to monitor drug resistance. The survey was conducted April-July 2015; 50 (87.7%) participated. Eighty percent of jurisdictions contacted all newly reported patients; 60% contacted all providers. HIV resistance tests were reportable in 38%; 66% contacted providers and/or patients about missed viral loads. Non-federal funding was significantly associated with annual diagnoses (p = .0001) and population (p = .0002), but not with other factors studied. Many jurisdictions lacked non-federal funding (28%), or experienced unrestored reductions since 2008 (33%). Jurisdictions' funding and preventive practices varied greatly. HIV viral suppression could be enhanced by restoring (or establishing) non-federal prevention funding, and by more standardized surveillance/outreach practices.
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Affiliation(s)
- Ronald P Hattis
- Beyond AIDS Foundation and Loma Linda University, Loma Linda, California
| | - Richel Y Strydom
- Beyond AIDS Foundation and Loma Linda University, Loma Linda, California (the latter through February 2018)
| | | | - Deanna C Stover
- Beyond AIDS Foundation and the Community Health Association Inland Southern Region, San Bernardino, California
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31
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The health impact of human papillomavirus vaccination in the situation of primary human papillomavirus screening: A mathematical modeling study. PLoS One 2018; 13:e0202924. [PMID: 30180203 PMCID: PMC6122803 DOI: 10.1371/journal.pone.0202924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination and the implementation of primary HPV screening in the Netherlands will lead to a lower cervical disease burden. For evaluation and further improvement of prevention, it is important to estimate the magnitude and timing of health benefits of current and alternative vaccination strategies such as vaccination of boys or adults. METHODS AND FINDINGS We evaluated the impact of the current girls-only vaccination program and alternative strategies on cervical disease burden among the first four vaccinated five-year birth cohorts, given the context of primary HPV screening. We integrated the existing microsimulation models STDSIM (HPV transmission model) and MISCAN-Cervix (cervical cancer screening model). Alternative vaccination strategies include: improved vaccination uptake, including routine boys vaccination, and offering adult vaccination at sexual health clinics. Our models show that the current vaccination program is estimated to reduce cervical cancers and cancer deaths by about 35% compared to primary HPV screening in the absence of vaccination. The number needed to vaccinate (NNV) to gain 1 life year is 45. The most efficient alternative vaccination strategies are: 1) improving coverage of girls to 80% (NNV = 42); and 2) routine vaccination for girls and boys at 80% coverage (incremental NNV = 155), with cervical cancer mortality reductions estimated at 50% and 60% respectively. CONCLUSIONS While the current program already substantially reduces cervical cancer incidence and mortality, prevention can be further improved by increasing vaccination uptake and extending vaccination to boys. As not all cervical cancer deaths will be prevented, screening participation should still be encouraged.
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32
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How various design decisions on matching individuals in relationships affect the outcomes of microsimulations of sexually transmitted infection epidemics. PLoS One 2018; 13:e0202516. [PMID: 30157216 PMCID: PMC6114846 DOI: 10.1371/journal.pone.0202516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/03/2018] [Indexed: 11/19/2022] Open
Abstract
Microsimulations are increasingly used to estimate the prevalence of sexually transmitted infections (STIs). These models consist of agents which represent a sexually active population. Matching agents into sexual relationships is computationally intensive and presents modellers with difficult design decisions: how to select which partnerships between agents break up, which agents enter a partnership market, and how to pair agents in the partnership market. The aim of this study was to analyse the effect of these design decisions on STI prevalence. We compared two strategies for selecting which agents enter a daily partnership market and which agent partnerships break up: random selection in which agents are treated homogenously versus selection based on data from a large German longitudinal data set that accounts for sex, sexual orientation and age heterogeneity. We also coupled each of these strategies with one of several recently described algorithms for pairing agents and compared their speed and outcomes. Additional design choices were also considered, such as the number of agents used in the model, increasing the heterogeneity of agents' sexual behaviour, and the proportion of relationships which are casual sex encounters. Approaches which account for agent heterogeneity estimated lower prevalence than less sophisticated approaches which treat agents homogeneously. Also, in simulations with non-random pairing of agents, as the risk of infection increased, incidence declined as the number of agents increased. Our algorithms facilitate the execution of thousands of simulations with large numbers of agents quickly. Fast pair-matching algorithms provide a practical way for microsimulation modellers to account for varying sexual behaviour within the population they are studying. For STIs with high infection rates modellers may need to experiment with different population sizes.
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Rhead R, Elmes J, Otobo E, Nhongo K, Takaruza A, White PJ, Nyamukapa CA, Gregson S. Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe. BMJ Open 2018; 8:e018751. [PMID: 29490957 PMCID: PMC5855339 DOI: 10.1136/bmjopen-2017-018751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/01/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. METHODS Data from a household survey conducted in 2009-2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. RESULTS HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02-2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03-5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs' greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy. CONCLUSION FSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs' need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake.
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Affiliation(s)
- Rebecca Rhead
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Eloghene Otobo
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Kundai Nhongo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter J White
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London School of Public Health, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Constance Anesu Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
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Geffen N, Welte A. Modelling the human immunodeficiency virus (HIV) epidemic: A review of the substance and role of models in South Africa. South Afr J HIV Med 2018; 19:756. [PMID: 29568647 PMCID: PMC5843995 DOI: 10.4102/sajhivmed.v19i1.756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 01/01/2023] Open
Abstract
We review key mathematical models of the South African human immunodeficiency virus (HIV) epidemic from the early 1990s onwards. In our descriptions, we sometimes differentiate between the concepts of a model world and its mathematical or computational implementation. The model world is the conceptual realm in which we explicitly declare the rules – usually some simplification of ‘real world’ processes as we understand them. Computing details of informative scenarios in these model worlds is a task requiring specialist knowledge, but all other aspects of the modelling process, from describing the model world to identifying the scenarios and interpreting model outputs, should be understandable to anyone with an interest in the epidemic.
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Affiliation(s)
- Nathan Geffen
- Department of Computer Science, Centre for Social Science Research, University of Cape Town, South Africa
| | - Alex Welte
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch, South Africa
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35
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Kumi Smith M, Jewell BL, Hallett TB, Cohen MS. Treatment of HIV for the Prevention of Transmission in Discordant Couples and at the Population Level. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1075:125-162. [PMID: 30030792 DOI: 10.1007/978-981-13-0484-2_6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The scientific breakthrough proving that antiretroviral therapy (ART) can halt heterosexual HIV transmission came in the form of a landmark clinical trial conducted among serodiscordant couples. Study findings immediately informed global recommendations for the use of treatment as prevention in serodiscordant couples. The extent to which these findings are generalizable to other key populations or to groups exposed to HIV through nonsexual transmission routes (i.e., anal intercourse or unsafe injection of drugs) has since driven a large body of research. This review explores the history of HIV research in serodiscordant couples, the implications for management of couples, subsequent research on treatment as prevention in other key populations, and challenges in community implementation of these strategies.
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Affiliation(s)
- M Kumi Smith
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Myron S Cohen
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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36
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Geffen N, Low MO. When to start antiretroviral treatment? A history and analysis of a scientific controversy. South Afr J HIV Med 2017. [DOI: 10.4102/sajhivmed.v18i1.734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Since 1987 HIV scientists and activists have debated the optimal point to start antiretroviral treatment. Positions have varied between treating people with HIV as soon as they are diagnosed, based on biological, modelling and observational evidence, versus delaying treatment until points in disease progression at which clinical trial evidence has shown unequivocally that treatment is beneficial.Objectives: Examining the conduct and resolution of this debate may provide insight into how science works in practice. It also documents an important part of the history of the HIV epidemic.Method: We describe clinical trials, observational studies, models and various documents that have advanced the debate from 1987 to 2015.Results and conclusion: Evidence accumulated over the past decade, especially from randomised controlled clinical trials, has shown that immediate treatment both reduces the mortality and the risk of HIV transmission; it benefits both public health and the individual patient. By mid-2015, the debate was resolved in favour of immediate treatment.
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Grabowski MK, Serwadda DM, Gray RH, Nakigozi G, Kigozi G, Kagaayi J, Ssekubugu R, Nalugoda F, Lessler J, Lutalo T, Galiwango RM, Makumbi F, Kong X, Kabatesi D, Alamo ST, Wiersma S, Sewankambo NK, Tobian AAR, Laeyendecker O, Quinn TC, Reynolds SJ, Wawer MJ, Chang LW. HIV Prevention Efforts and Incidence of HIV in Uganda. N Engl J Med 2017; 377:2154-2166. [PMID: 29171817 PMCID: PMC5627523 DOI: 10.1056/nejmoa1702150] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participant-reported male circumcision, viral-load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) - from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94). CONCLUSIONS In this longitudinal study, the incidence of HIV infection declined significantly with the scale-up of a combination strategy for HIV prevention, which provides empirical evidence that interventions for HIV prevention can have a population-level effect. However, additional efforts are needed to overcome disparities according to sex and to achieve greater reductions in the incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Affiliation(s)
- M Kate Grabowski
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - David M Serwadda
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Ronald H Gray
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Gertrude Nakigozi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Godfrey Kigozi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Joseph Kagaayi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Robert Ssekubugu
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Fred Nalugoda
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Justin Lessler
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Thomas Lutalo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Ronald M Galiwango
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Fred Makumbi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Xiangrong Kong
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Donna Kabatesi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Stella T Alamo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Steven Wiersma
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Nelson K Sewankambo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Aaron A R Tobian
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Oliver Laeyendecker
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Thomas C Quinn
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Steven J Reynolds
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Maria J Wawer
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Larry W Chang
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
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Higher risk sexual behaviour is associated with unawareness of HIV-positivity and lack of viral suppression - implications for Treatment as Prevention. Sci Rep 2017; 7:16117. [PMID: 29170407 PMCID: PMC5700952 DOI: 10.1038/s41598-017-16382-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 11/13/2017] [Indexed: 11/08/2022] Open
Abstract
Efficacy of Treatment as Prevention Strategy depends on a variety of factors including individuals’ likelihood to test and initiate treatment, viral load and sexual behaviour. We tested the hypothesis that people with higher risk sexual behaviour are less likely to know their HIV-positive status and be virologically suppressed. A cross-sectional population-based survey of individuals aged 15–59 years old was conducted in 2013 in KwaZulu-Natal, South Africa. A two-stage cluster probability sampling was used. After adjustment for age and sex, lack of awareness of HIV-positivity was strongly associated with having more than one sexual partner in the preceding year (aOR: 2.1, 95%CI: 1.5–3.1). Inconsistent condom use was more common in individuals with more than one sexual partner (aOR: 16.6, 95%CI: 7.6–36.7) and those unaware (aOR: 3.7, 95%CI: 2.6–5.4). Among people aware of their HIV-positivity, higher risk sexual behaviour was associated with lack of viral suppression (aOR: 2.2, 95%CI: 1.1–4.5). Risky sexual behaviour seems associated with factors linked to poor health-seeking behaviour which may have negative implications for HIV testing and Treatment as Prevention. Innovative strategies, driven by improved epidemiological and anthropological understanding, are needed to enable comprehensive approaches to HIV prevention.
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Thomas R, Burger R, Harper A, Kanema S, Mwenge L, Vanqa N, Bell-Mandla N, Smith PC, Floyd S, Bock P, Ayles H, Beyers N, Donnell D, Fidler S, Hayes R, Hauck K. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial. Lancet Glob Health 2017; 5:e1133-e1141. [PMID: 28964756 PMCID: PMC5640509 DOI: 10.1016/s2214-109x(17)30367-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/14/2017] [Accepted: 08/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa. METHODS As part of the HPTN 071 (PopART) study, data from adults aged 18-44 years were gathered between Nov 28, 2013, and March 31, 2015, in large cross-sectional surveys of random samples of the general population in 21 communities in Zambia and South Africa. HRQoL data were collected with a standardised generic measure of health across five domains. We used β-distributed multivariable models to analyse differences in HRQoL scores between HIV-negative and HIV-positive individuals who were unaware of their status; aware, but not in HIV care; in HIV care, but who had not initiated ART; on ART for less than 5 years; and on ART for 5 years or more. We included controls for sociodemographic variables, herpes simplex virus type-2 status, and recreational drug use. FINDINGS We obtained data for 19 750 respondents in Zambia and 18 941 respondents in South Africa. Laboratory-confirmed HIV status was available for 19 330 respondents in Zambia and 18 004 respondents in South Africa; 4128 (21%) of these 19 330 respondents in Zambia and 4012 (22%) of 18 004 respondents in South Africa had laboratory-confirmed HIV. We obtained complete HRQoL information for 19 637 respondents in Zambia and 18 429 respondents in South Africa. HRQoL scores did not differ significantly between individuals who had initiated ART more than 5 years previously and HIV-negative individuals, neither in Zambia (change in mean score -0·002, 95% CI -0·01 to 0·001; p=0·219) nor in South Africa (0·000, -0·002 to 0·003; p=0·939). However, scores did differ between HIV-positive individuals who had initiated ART less than 5 years previously and HIV-negative individuals in Zambia (-0·006, 95% CI -0·008 to -0·003; p<0·0001). A large proportion of people with clinically confirmed HIV were unaware of being HIV-positive (1768 [43%] of 4128 people in Zambia and 2026 [50%] of 4012 people in South Africa) and reported good HRQoL, with no significant differences from that of HIV-negative people (change in mean HRQoL score -0·001, 95% CI -0·003 to 0·001, p=0·216; and 0·001, -0·001 to 0·001, p=0·997, respectively). In South Africa, HRQoL scores were lower in HIV-positive individuals who were aware of their status but not enrolled in HIV care (change in mean HRQoL -0·004, 95% CI -0·01 to -0·001; p=0·010) and those in HIV care but not on ART (-0·008, -0·01 to -0·004; p=0·001) than in HIV-negative people, but the magnitudes of difference were small. INTERPRETATION ART is successful in helping to reduce inequalities in HRQoL between HIV-positive and HIV-negative individuals in this general population sample. These findings highlight the importance of improving awareness of HIV status and expanding ART to prevent losses in HRQoL that occur with untreated HIV progression. The gains in HRQoL after individuals initiate ART could be substantial when scaled up to the population level. FUNDING National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, National Institute of Mental Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Abigail Harper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Kanema
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Lawrence Mwenge
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Peter C Smith
- Imperial College Business School, Imperial College London, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Nah K, Nishiura H, Tsuchiya N, Sun X, Asai Y, Imamura A. Test-and-treat approach to HIV/AIDS: a primer for mathematical modeling. Theor Biol Med Model 2017; 14:16. [PMID: 28870213 PMCID: PMC5583977 DOI: 10.1186/s12976-017-0062-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/18/2017] [Indexed: 12/13/2022] Open
Abstract
The public benefit of test-and-treat has induced a need to justify goodness for the public, and mathematical modeling studies have played a key role in designing and evaluating the test-and-treat strategy for controlling HIV/AIDS. Here we briefly and comprehensively review the essence of contemporary understanding of the test-and-treat policy through mathematical modeling approaches and identify key pitfalls that have been identified to date. While the decrease in HIV incidence is achieved with certain coverages of diagnosis, care and continued treatment, HIV prevalence is not necessarily decreased and sometimes the test-and-treat is accompanied by increased long-term cost of antiretroviral therapy (ART). To confront with the complexity of assessment on this policy, the elimination threshold or the effective reproduction number has been proposed for its use in determining the overall success to anticipate the eventual elimination. Since the publication of original model in 2009, key issues of test-and-treat modeling studies have been identified, including theoretical problems surrounding the sexual partnership network, heterogeneities in the transmission dynamics, and realistic issues of achieving and maintaining high treatment coverage in the most hard-to-reach populations. To explicitly design country-specific control policy, quantitative modeling approaches to each single setting with differing epidemiological context would require multi-disciplinary collaborations among clinicians, public health practitioners, laboratory technologists, epidemiologists and mathematical modelers.
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Affiliation(s)
- Kyeongah Nah
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo, 060-8638, Japan.,CREST, Japan Science and Technology Agency, 4-1-8, Honcho, Kawaguchi-shi, Saitama, 332-0012, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo, 060-8638, Japan. .,CREST, Japan Science and Technology Agency, 4-1-8, Honcho, Kawaguchi-shi, Saitama, 332-0012, Japan.
| | - Naho Tsuchiya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8573, Japan
| | - Xiaodan Sun
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo, 060-8638, Japan.,Department of Applied Mathematics, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yusuke Asai
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo, 060-8638, Japan.,CREST, Japan Science and Technology Agency, 4-1-8, Honcho, Kawaguchi-shi, Saitama, 332-0012, Japan
| | - Akifumi Imamura
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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42
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Egger M, Johnson L, Althaus C, Schöni A, Salanti G, Low N, Norris SL. Developing WHO guidelines: Time to formally include evidence from mathematical modelling studies. F1000Res 2017; 6:1584. [PMID: 29552335 PMCID: PMC5829466 DOI: 10.12688/f1000research.12367.2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 12/15/2022] Open
Abstract
In recent years, the number of mathematical modelling studies has increased steeply. Many of the questions addressed in these studies are relevant to the development of World Health Organization (WHO) guidelines, but modelling studies are rarely formally included as part of the body of evidence. An expert consultation hosted by WHO, a survey of modellers and users of modelling studies, and literature reviews informed the development of recommendations on when and how to incorporate the results of modelling studies into WHO guidelines. In this article, we argue that modelling studies should routinely be considered in the process of developing WHO guidelines, but particularly in the evaluation of public health programmes, long-term effectiveness or comparative effectiveness. There should be a systematic and transparent approach to identifying relevant published models, and to commissioning new models. We believe that the inclusion of evidence from modelling studies into the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process is possible and desirable, with relatively few adaptations. No single "one-size-fits-all" approach is appropriate to assess the quality of modelling studies. The concept of the 'credibility' of the model, which takes the conceptualization of the problem, model structure, input data, different dimensions of uncertainty, as well as transparency and validation into account, is more appropriate than 'risk of bias'.
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Affiliation(s)
- Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland.,Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, 7925, South Africa
| | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, 7925, South Africa
| | - Christian Althaus
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
| | - Anna Schöni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
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43
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Egger M, Johnson L, Althaus C, Schöni A, Salanti G, Low N, Norris SL. Developing WHO guidelines: Time to formally include evidence from mathematical modelling studies. F1000Res 2017; 6:1584. [PMID: 29552335 DOI: 10.12688/f1000research.12367.1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 12/15/2022] Open
Abstract
In recent years, the number of mathematical modelling studies has increased steeply. Many of the questions addressed in these studies are relevant to the development of World Health Organization (WHO) guidelines, but modelling studies are rarely formally included as part of the body of evidence. An expert consultation hosted by WHO, a survey of modellers and users of modelling studies, and literature reviews informed the development of recommendations on when and how to incorporate the results of modelling studies into WHO guidelines. In this article, we argue that modelling studies should routinely be considered in the process of developing WHO guidelines, but particularly in the evaluation of public health programmes, long-term effectiveness or comparative effectiveness. There should be a systematic and transparent approach to identifying relevant published models, and to commissioning new models. We believe that the inclusion of evidence from modelling studies into the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process is possible and desirable, with relatively few adaptations. No single "one-size-fits-all" approach is appropriate to assess the quality of modelling studies. The concept of the 'credibility' of the model, which takes the conceptualization of the problem, model structure, input data, different dimensions of uncertainty, as well as transparency and validation into account, is more appropriate than 'risk of bias'.
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Affiliation(s)
- Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland.,Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, 7925, South Africa
| | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research (CIDER), University of Cape Town, Cape Town, 7925, South Africa
| | - Christian Althaus
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
| | - Anna Schöni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, 3012, Switzerland
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Blaizot S, Huerga H, Riche B, Ellman T, Shroufi A, Etard JF, Ecochard R. Combined interventions to reduce HIV incidence in KwaZulu-Natal: a modelling study. BMC Infect Dis 2017; 17:522. [PMID: 28747167 PMCID: PMC5530541 DOI: 10.1186/s12879-017-2612-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combined prevention interventions, including early antiretroviral therapy initiation, may substantially reduce HIV incidence in hyperendemic settings. Our aim was to assess the potential short-term impact of combined interventions on HIV spreading in the adult population of Mbongolwane and Eshowe (KwaZulu-Natal, South Africa) using sex- and age-specific scenarios, and age-targeted interventions. METHODS A mathematical model was used with data on adults (15-59 years) from the Mbongolwane and Eshowe HIV Impact in Population Survey to compare the effects of various interventions on the HIV incidence rate. These interventions included increase in antiretroviral therapy (ART) coverage with extended eligibility criteria, increase in voluntary medical male circumcision (VMMC), and implementation of pre-exposure prophylaxis (PrEP) among women. RESULTS With no additional interventions to the ones in place at the time of the survey (ART at CD4 < 350 and VMMC), incidence will decrease by 24% compared to the baseline rate. The implementation of "ART at CD4<500" or "ART for all" would reduce further the incidence rate by additional 8% and 15% respectively by 4 years and 20% and 34% by 10 years. Impacts would be higher with age-targeted scenarios than without. CONCLUSIONS In Mbongolwane and Eshowe, implementation of the new South African guidelines, recommending ART initiation regardless of CD4 count, would accelerate incidence reduction. In this setting, combining these guidelines, VMMC, and PrEP among young women could be an effective strategy in reducing the incidence to low levels.
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Affiliation(s)
- Stéphanie Blaizot
- Service de Biostatistique, Hospices Civils de Lyon, F-69003 Lyon, France
- Université de Lyon, F-69000 Lyon, France
- Université Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100 Villeurbanne, France
| | | | - Benjamin Riche
- Service de Biostatistique, Hospices Civils de Lyon, F-69003 Lyon, France
- Université de Lyon, F-69000 Lyon, France
- Université Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100 Villeurbanne, France
| | - Tom Ellman
- Médecins Sans Frontières, Cape Town, South Africa
| | - Amir Shroufi
- Médecins Sans Frontières, Cape Town, South Africa
| | - Jean-François Etard
- Epicentre, F-75011 Paris, France
- IRD UMI 233, INSERM U1175, Université de Montpellier, Unité TransVIHMI, F-34000 Montpellier, France
| | - René Ecochard
- Service de Biostatistique, Hospices Civils de Lyon, F-69003 Lyon, France
- Université de Lyon, F-69000 Lyon, France
- Université Lyon 1, F-69100 Villeurbanne, France
- CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100 Villeurbanne, France
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Legemate EM, Hontelez JAC, Looman CWN, de Vlas SJ. Behavioural disinhibition in the general population during the antiretroviral therapy roll-out in Sub-Saharan Africa: systematic review and meta-analysis. Trop Med Int Health 2017; 22:797-806. [PMID: 28449332 DOI: 10.1111/tmi.12885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Improved life expectancy and reduced transmission probabilities due to ART may result in behavioural disinhibition - that is an increase in sexual risk behaviour in response to a perceived lower risk of HIV. We examined trends in sexual risk behaviour in the general population of sub-Saharan African countries 1999-2015. METHODS We systematically reviewed scientific literature of sexual behaviour and reviewed trends in Demographic and Health Surveys. A meta-analysis on four indicators of sexual risk behaviour was performed: unprotected sex, multiple sexual partners, commercial sex and prevalence of sexually transmitted infections. RESULTS Only two peer-reviewed studies met our inclusion criteria, while our review of DHS data spanned 18 countries and 16 years (1999-2015). We found conflicting trends in sexual risk behaviour. Reported unprotected sex decreased consistently across the 18 countries, for both sexes. In contrast, reporting multiple partners was decreasing over the period 1999 to the mid-2000s, yet has been consistently increasing thereafter. Similar trends were found for reported sexually transmitted infections and commercial sex (men only). CONCLUSIONS In conclusion, we found no clear evidence of behavioural disinhibition due to expanded access to ART in sub-Saharan Africa. Substantial increases in condom use coincided with increases in reported multiple partners, commercial sex and sexually transmitted infections, especially during the period of ART scale-up. Further research is needed into how these changes might affect HIV transmission.
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Affiliation(s)
- Eva M Legemate
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A C Hontelez
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Bradley BD, Jung T, Tandon-Verma A, Khoury B, Chan TCY, Cheng YL. Operations research in global health: a scoping review with a focus on the themes of health equity and impact. Health Res Policy Syst 2017; 15:32. [PMID: 28420381 PMCID: PMC5395767 DOI: 10.1186/s12961-017-0187-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/06/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Operations research (OR) is a discipline that uses advanced analytical methods (e.g. simulation, optimisation, decision analysis) to better understand complex systems and aid in decision-making. Herein, we present a scoping review of the use of OR to analyse issues in global health, with an emphasis on health equity and research impact. A systematic search of five databases was designed to identify relevant published literature. A global overview of 1099 studies highlights the geographic distribution of OR and common OR methods used. From this collection of literature, a narrative description of the use of OR across four main application areas of global health - health systems and operations, clinical medicine, public health and health innovation - is also presented. The theme of health equity is then explored in detail through a subset of 44 studies. Health equity is a critical element of global health that cuts across all four application areas, and is an issue particularly amenable to analysis through OR. Finally, we present seven select cases of OR analyses that have been implemented or have influenced decision-making in global health policy or practice. Based on these cases, we identify three key drivers for success in bridging the gap between OR and global health policy, namely international collaboration with stakeholders, use of contextually appropriate data, and varied communication outlets for research findings. Such cases, however, represent a very small proportion of the literature found. CONCLUSION Poor availability of representative and quality data, and a lack of collaboration between those who develop OR models and stakeholders in the contexts where OR analyses are intended to serve, were found to be common challenges for effective OR modelling in global health.
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Affiliation(s)
- Beverly D Bradley
- Centre for Global Engineering, University of Toronto, Toronto, ON, Canada. .,Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada.
| | - Tiffany Jung
- Centre for Global Engineering, University of Toronto, Toronto, ON, Canada.,Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada
| | - Ananya Tandon-Verma
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Bassem Khoury
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Timothy C Y Chan
- Centre for Global Engineering, University of Toronto, Toronto, ON, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.,Centre for Healthcare Engineering, University of Toronto, Toronto, ON, Canada
| | - Yu-Ling Cheng
- Centre for Global Engineering, University of Toronto, Toronto, ON, Canada.,Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College St, Toronto, ON, M5S 3E5, Canada
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47
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Affiliation(s)
- Ian Woolley
- a Monash Infectious Diseases, Monash Health and Departments of Medicine and Infectious Diseases , Monash University , Clayton , VIC , Australia
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48
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Bartsch SM, Peterson JK, Hertenstein DL, Skrip L, Ndeffo-Mbah M, Galvani AP, Dobson AP, Lee BY. Comparison and validation of two computational models of Chagas disease: A thirty year perspective from Venezuela. Epidemics 2017; 18:81-91. [PMID: 28279459 PMCID: PMC5549789 DOI: 10.1016/j.epidem.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mathematical models can help aid public health responses to Chagas disease. Models are typically developed to fulfill a particular need, and comparing outputs from different models addressing the same question can help identify the strengths and weaknesses of the models in answering particular questions, such as those for achieving the 2020 goals for Chagas disease. METHODS Using two separately developed models (PHICOR/CIDMA model and Princeton model), we simulated dynamics for domestic transmission of Trypanosoma cruzi (T. cruzi). We compared how well the models targeted the last 9 years and last 19 years of the 1968-1998 historical seroprevalence data from Venezuela. RESULTS Both models were able to generate the T. cruzi seroprevalence for the next time period within reason to the historical data. The PHICOR/CIDMA model estimates of the total population seroprevalence more closely followed the trends seen in the historic data, while the Princeton model estimates of the age-specific seroprevalence more closely followed historic trends when simulating over 9 years. Additionally, results from both models overestimated T. cruzi seroprevalence among younger age groups, while underestimating the seroprevalence of T. cruzi in older age groups. CONCLUSION The PHICOR/CIDMA and Princeton models differ in level of detail and included features, yet both were able to generate the historical changes in T. cruzi seroprevalence in Venezuela over 9 and 19-year time periods. Our model comparison has demonstrated that different model structures can be useful in evaluating disease transmission dynamics and intervention strategies.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, United States; Global Obesity Prevention Center, Johns Hopkins University, United States
| | - Jennifer K Peterson
- Department of Ecology and Evolutionary Biology, Princeton University, United States
| | - Daniel L Hertenstein
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, United States; Global Obesity Prevention Center, Johns Hopkins University, United States
| | - Laura Skrip
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, United States
| | - Martial Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, United States
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, United States
| | - Andrew P Dobson
- Department of Ecology and Evolutionary Biology, Princeton University, United States
| | - Bruce Y Lee
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, United States; Global Obesity Prevention Center, Johns Hopkins University, United States.
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Le Rutte EA, Chapman LAC, Coffeng LE, Jervis S, Hasker EC, Dwivedi S, Karthick M, Das A, Mahapatra T, Chaudhuri I, Boelaert MC, Medley GF, Srikantiah S, Hollingsworth TD, de Vlas SJ. Elimination of visceral leishmaniasis in the Indian subcontinent: a comparison of predictions from three transmission models. Epidemics 2017; 18:67-80. [PMID: 28279458 PMCID: PMC5340844 DOI: 10.1016/j.epidem.2017.01.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 12/23/2022] Open
Abstract
We present three transmission models of visceral leishmaniasis (VL) in the Indian subcontinent (ISC) with structural differences regarding the disease stage that provides the main contribution to transmission, including models with a prominent role of asymptomatic infection, and fit them to recent case data from 8 endemic districts in Bihar, India. Following a geographical cross-validation of the models, we compare their predictions for achieving the WHO VL elimination targets with ongoing treatment and vector control strategies. All the transmission models suggest that the WHO elimination target (<1 new VL case per 10,000 capita per year at sub-district level) is likely to be met in Bihar, India, before or close to 2020 in sub-districts with a pre-control incidence of 10 VL cases per 10,000 people per year or less, when current intervention levels (60% coverage of indoor residual spraying (IRS) of insecticide and a delay of 40days from onset of symptoms to treatment (OT)) are maintained, given the accuracy and generalizability of the existing data regarding incidence and IRS coverage. In settings with a pre-control endemicity level of 5/10,000, increasing the effective IRS coverage from 60 to 80% is predicted to lead to elimination of VL 1-3 years earlier (depending on the particular model), and decreasing OT from 40 to 20days to bring elimination forward by approximately 1year. However, in all instances the models suggest that L. donovani transmission will continue after 2020 and thus that surveillance and control measures need to remain in place until the longer-term aim of breaking transmission is achieved.
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Affiliation(s)
- Epke A Le Rutte
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Lloyd A C Chapman
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, United Kingdom
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sarah Jervis
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, United Kingdom
| | - Epco C Hasker
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Shweta Dwivedi
- CARE India Solutions for Sustainable Development, Patna, Bihar, India
| | - Morchan Karthick
- CARE India Solutions for Sustainable Development, Patna, Bihar, India
| | - Aritra Das
- CARE India Solutions for Sustainable Development, Patna, Bihar, India
| | - Tanmay Mahapatra
- CARE India Solutions for Sustainable Development, Patna, Bihar, India
| | | | - Marleen C Boelaert
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Graham F Medley
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | | | - T Deirdre Hollingsworth
- School of Life Sciences, University of Warwick, Gibbet Hill Campus, Coventry CV4 7AL, United Kingdom
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis 2016; 44:66-73. [PMID: 26948920 DOI: 10.1016/j.ijid.2015.11.008] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To give an overview of the HIV epidemic in the Middle East and North Africa (MENA) region. METHODS Articles on the MENA region were reviewed. RESULTS The MENA region comprises a geographically defined group of countries including both high-income, well-developed nations and low- and middle-income countries. While the annual number of new HIV infections in Sub-Saharan Africa has declined by 33% since 2005, new HIV infections in the MENA region have increased by 31% since 2001, which is the highest increase among all regions in the world. Moreover, the number of AIDS-related deaths in 2013 was estimated to be 15000, representing a 66% increase since 2005. However, the current prevalence of 0.1% is still among the lowest rates globally. There is substantial heterogeneity in HIV epidemic dynamics across MENA, and different risk contexts are present throughout the region. Despite unfavorable conditions, many countries in the region have put significant effort into scaling up their response to this growing epidemic, while in others the response to HIV is proving slower due to denial, stigma, and reluctance to address sensitive issues. CONCLUSIONS The HIV epidemic in the MENA region is still at a controllable level, and this opportunity should not be missed.
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Affiliation(s)
- Deniz Gökengin
- Department of Clinical Microbiology and Infectious Diseases, Medical Faculty, Ege University, Bornova, Izmir, Turkey.
| | - Fardad Doroudi
- UNAIDS - The Joint United Nations Programme on HIV/AIDS (UNAIDS), Islamic Republic of Iran.
| | - Johnny Tohme
- M-Coalition, Yazbeck Center, Achrafieh, Beirut, Lebanon.
| | | | - Navid Madani
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
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