Department of Infectious Diseases Epidemiology, Imperial College London, Norfolk Square, London W2 1PG, UK.
Curr Opin HIV AIDS. 2014 Mar;9(2):134-49. doi: 10.1097/COH.0000000000000036.
This review summarizes recent mathematical modelling studies conducted among key populations including MSM, people who inject drugs (PWID), and female sex workers (FSWs) in low prevalence settings used as a marker of concentrated epidemics.
Most recent studies focused on MSM, Asian settings or high-income countries, studied the transmission dynamics or modelled pre-exposure prophylaxis, treatment as prevention or behavioural interventions specific to each key population (e.g., needle exchange programme or use of low-dead space syringes for PWID). Biological interventions were deemed effective and cost-effective, though still expensive, and often deemed unlikely to result in HIV elimination if used alone. Targeting high-risk individuals even within key populations improved efficiency. Some studies made innovative use of models to formally evaluate HIV prevention programmes, to interpret genetic or co-infection data, and to address methodological questions and validate epidemiological tools.
More work is needed to optimize combination prevention focusing on key populations in different settings. The gaps identified include the limited number of studies modelling drug resistance, structural interventions, treatment as prevention among FSWs, and estimating the contribution of key populations to overall transmission in different settings.
本次综述总结了最近在包括男男性行为者（MSM）、注射吸毒者（PWID）和性工作者（FSW）在内的重点人群中进行的数学建模研究，这些研究是在低流行地区开展的，作为集中流行的指标。
最近的研究主要集中在 MSM、亚洲地区或高收入国家，研究了传播动力学，或针对每个重点人群（如 PWID 的针具交换项目或使用低死腔注射器）建立了暴露前预防、治疗即预防或行为干预的模型。尽管生物干预措施被认为是有效且具有成本效益的，但仍很昂贵，如果单独使用，往往不太可能导致 HIV 消除。针对重点人群中的高风险个体，提高了干预的效率。一些研究创新性地使用模型来正式评估 HIV 预防方案，解释遗传或合并感染数据，并解决方法学问题和验证流行病学工具。
需要进一步研究，以优化针对不同环境下重点人群的综合预防措施。确定的差距包括：建模药物耐药性、结构干预措施、FSW 中治疗即预防以及估计重点人群在不同环境下对整体传播的贡献等方面的研究数量有限。
