de Boer Rebecca, Musgrave Jeffrey, Andersson Neil, Lutscher Frithjof
Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada.
Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
PLoS One. 2017 Apr 11;12(4):e0175297. doi: 10.1371/journal.pone.0175297. eCollection 2017.
Despite massive investment in HIV control programs, HIV incidence rates in countries with generalized epidemics have not fallen for most of the last decade. It appears that those at risk are not adopting effective prevention strategies. Those who are unable to implement their prevention preferences are referred to as choice disabled. We examined how and to what extent structural intervention measures that support choice-disabled individuals can reduce HIV transmission and prevalence.
A mathematical model was developed to describe HIV transmission among and between choice-disabled and choice-enabled individuals. Data were available from field trials identifying factors and effects of choice disability. The model was used to estimate the potential impact of an intervention strategy in which choice-disabled individuals are enabled to make prevention choices. Several scenarios were considered and compared: supporting only one or both genders; supporting only HIV- individuals or also HIV+ choice-disabled individuals.
Substantial declines in HIV incidence and prevalence are observed when supportive interventions are included in the model. The magnitude of these declines depends on the scope of the intervention program. The largest positive effect occurs when the support program is offered regardless of HIV status.
Addressing the effects of choice disability in any HIV intervention program could be crucial to the program's success. Structural intervention programs to support choice-disabled individuals in implementing prevention strategies greatly reduce HIV incidence and prevalence in mathematical models.
尽管在艾滋病病毒防控项目上投入巨大，但在过去十年的大部分时间里，艾滋病病毒广泛流行国家的发病率并未下降。似乎高危人群并未采取有效的预防策略。那些无法实施其预防偏好的人被称为选择障碍者。我们研究了支持选择障碍者的结构性干预措施如何以及在多大程度上能够降低艾滋病病毒的传播和流行率。
建立了一个数学模型来描述选择障碍者和有选择能力者之间以及他们内部的艾滋病病毒传播情况。数据来自于确定选择障碍因素和影响的现场试验。该模型用于估计一项干预策略的潜在影响，该策略旨在使选择障碍者能够做出预防选择。考虑并比较了几种情况：仅支持一种性别或两种性别；仅支持艾滋病病毒阴性者或也支持艾滋病病毒阳性的选择障碍者。
当模型中纳入支持性干预措施时，观察到艾滋病病毒发病率和流行率大幅下降。这些下降的幅度取决于干预项目的范围。当无论艾滋病病毒感染状况都提供支持项目时，会产生最大的积极效果。
在任何艾滋病病毒干预项目中解决选择障碍的影响可能对项目的成功至关重要。在数学模型中，支持选择障碍者实施预防策略的结构性干预项目能大幅降低艾滋病病毒的发病率和流行率。
