Lou Jie, Hu Peipei, Qian Han-Zhu, Ruan Yuhua, Jin Zhen, Xing Hui, Shao Yiming, Vermund Sten H
Department of Mathematics, Shanghai University, Shanghai, China.
Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America.
PLoS One. 2017 Apr 13;12(4):e0171295. doi: 10.1371/journal.pone.0171295. eCollection 2017.
To project the impact of partner reduction on preventing new HIV infections among men who have sex with men (MSM) under varying conditions of enhanced HIV testing and treatment (T&T) and condom use in Beijing, China.
A complex network model was fitted to predict the number of new HIV infections averted from 2014 to 2023 under four scenarios of sexual behavior risk reduction (S)-S1: Male sexual partners decrease (reduced by a random value m from 1-50) while condom use increases (risk constant p is a random value between 0.2 and 1]); S2: Both sexual partners and condom use decrease (m 1, 50; p 1, 1.8); S3: Sexual partners reduce (m 1, 10) while condom use increases or decreases (p 0.2, 1.8); S4: Only MSM with ≥100 male sexual partners reduce their partners (m 1, 50) while condom use increases (p 0.2, 1). HIV prevalence will reach 23.2% by 2023 among Beijing MSM if T&T remains at the 2013 level. The three most influential factors are: T&T coverage; partner reduction (m); and the background risk (p). Under scenarios 1-4 of sexual behavioral changes with enhanced T&T interventions, the cumulative HIV new infections prevented over the 10 years will be 46.8% for S1 (interquartile range [IQR] 32.4%, 60.1%); 29.7% for S2 (IQR 18.0%, 41.4%), 23.2% for S3 (IQR 12.2%, 37.0%) and 11.6% for S4 (IQR 4.0%, 26.6%), respectively. The reproduction number R0 could drop below 1 if there were a substantial reduction of male sexual partners and/or expanded condom use.
Partner reduction is a vital factor within HIV combination interventions to reduce HIV incidence among Beijing MSM, with substantial additional benefits derived from condom use. T&T without substantial partner reduction and increased condom use is less promising unless its implementation were extremely (and improbably) efficient.
预测在中国北京，在不同的艾滋病病毒强化检测与治疗（检测与治疗）及避孕套使用条件下，性伴减少对预防男男性行为者（MSM）新发艾滋病病毒感染的影响。
采用复杂网络模型预测2014年至2023年在四种性行为风险降低情景（S）下避免的新发艾滋病病毒感染数量——S1：男性性伴减少（随机减少1至50个），同时避孕套使用增加（风险常数p为0.2至1之间的随机值）；S2：性伴和避孕套使用均减少（m为1至50；p为1至1.8）；S3：性伴减少（m为1至10），同时避孕套使用增加或减少（p为0.2至1.8）；S4：仅性伴≥100个的男男性行为者减少其性伴（m为1至50），同时避孕套使用增加（p为0.2至1）。如果检测与治疗维持在2013年水平，到2023年北京男男性行为者中的艾滋病病毒流行率将达到23.2%。三个最具影响力的因素为：检测与治疗覆盖率；性伴减少（m）；以及背景风险（p）。在强化检测与治疗干预下的性行为变化情景1至4中，10年间预防的艾滋病病毒新感染累计数分别为：S1为46.8%（四分位间距[IQR]为32.4%，60.1%）；S2为29.7%（IQR为18.0%，41.4%），S3为23.2%（IQR为12.2%，37.0%），S4为11.6%（IQR为4.0%，26.6%）。如果男性性伴大幅减少和/或避孕套使用增加，繁殖数R0可能降至1以下。
性伴减少是艾滋病病毒综合干预措施中降低北京男男性行为者艾滋病病毒发病率的关键因素，增加避孕套使用可带来显著额外益处。如果没有大幅减少性伴和增加避孕套使用，检测与治疗的前景不太乐观，除非其实施效率极高（且不太可能）。
