Abuelezam Nadia N, McCormick Alethea W, Fussell Thomas, Afriyie Abena N, Wood Robin, DeGruttola Victor, Freedberg Kenneth A, Lipsitch Marc, Seage George R
Am J Epidemiol. 2016 Aug 1;184(3):239-48. doi: 10.1093/aje/kwv344. Epub 2016 Jul 13.
Little is known about how combining efficacious interventions for human immunodeficiency virus (HIV) prevention could lead to HIV elimination. We used an agent-based simulation model, the HIV calibrated dynamic model, to assess the potential for HIV elimination in South Africa. We examined several scenarios (from continuation of the current status quo to perfect achievement of targets) with differing combinations of male condom use, adult male circumcision, HIV testing, and early antiretroviral therapy (ART). We varied numerous parameters, including the proportion of adult males circumcised, the frequency of condom use during sex acts, acceptance of HIV testing, linkage to health care, criteria for ART initiation, ART viral suppression rates, and loss to follow-up. Maintaining current levels of combination prevention would lead to increasing HIV incidence and prevalence in South Africa, while the perfect combination scenario was projected to eliminate HIV on a 50-year time scale from 2013 to 2063. Perfecting testing and treatment, without changing condom use or circumcision rates, resulted in an 89% reduction in HIV incidence but not elimination. Universal adult male circumcision alone resulted in a 21% incidence reduction within 20 years. Substantial decreases in HIV incidence are possible from sufficient uptake of both primary prevention and ART, but with continuation of the status quo, HIV elimination in South Africa is unlikely within a 50-year time scale.
关于如何将有效的人类免疫缺陷病毒（HIV）预防干预措施相结合以实现HIV消除，人们了解甚少。我们使用了一个基于主体的模拟模型——HIV校准动态模型，来评估南非消除HIV的可能性。我们考察了几种情景（从维持现状到完美实现目标），这些情景涉及男性使用避孕套、成年男性包皮环切术、HIV检测以及早期抗逆转录病毒疗法（ART）的不同组合。我们改变了众多参数，包括成年男性接受包皮环切术的比例、性行为期间使用避孕套的频率、接受HIV检测的情况、与医疗保健的联系、ART启动标准、ART病毒抑制率以及失访情况。维持当前的综合预防水平将导致南非HIV发病率和患病率上升，而完美组合情景预计在2013年至2063年的50年时间尺度上消除HIV。在不改变避孕套使用或包皮环切率的情况下完善检测和治疗，可使HIV发病率降低89%，但无法实现消除。仅普遍实施成年男性包皮环切术可在20年内使发病率降低21%。通过充分采用一级预防和ART，HIV发病率可能大幅下降，但如果维持现状，南非在50年时间尺度内不太可能消除HIV。
