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Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015).

作者信息

Maheu-Giroux Mathieu, Vesga Juan F, Diabaté Souleymane, Alary Michel, Baral Stefan, Diouf Daouda, Abo Kouamé, Boily Marie-Claude

机构信息

*Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada; †Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, United Kingdom; ‡Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; §Département d'infectiologie et santé publique, Université Alassane Ouattara, Bouaké, Côte d'Ivoire; ‖Département de médecine sociale et préventive, Université Laval, Québec, Canada; ¶Key Populations Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; #Enda Santé, Dakar, Sénégal; and **Programme National de Lutte Contre le SIDA, Ministère de la santé et de l'hygiène publique, Abidjan, Côte d'Ivoire.

出版信息

J Acquir Immune Defic Syndr. 2017 Aug 15;75(5):517-527. doi: 10.1097/QAI.0000000000001434.


DOI:10.1097/QAI.0000000000001434
PMID:28471837
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5508974/
Abstract

INTRODUCTION: Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. METHODS: An age-stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). RESULTS: Overall, condom use averted 61% (95% credible intervals: 56%-66%) of all adult infections during 1987-2015 mainly because of increased use by FSW (46% of infections averted). In comparison, ART prevented 15% (10%-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91%-97%) of all new infections, declining to 19% (11%-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributors to transmission. Men who have sex with men contributed ≤4% transmissions throughout. Young women (15-24 years; excluding FSW) do not transmit more infections than they acquired. CONCLUSIONS: Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSWs and older men have become the main source of transmission, whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and clients of female sex workers, is important.

摘要

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本文引用的文献

[1]
Determinants of time from HIV infection to linkage-to-care in rural KwaZulu-Natal, South Africa.

AIDS. 2017-4-24

[2]
Data and methods to characterize the role of sex work and to inform sex work programs in generalized HIV epidemics: evidence to challenge assumptions.

Ann Epidemiol. 2016-8

[3]
Pre-exposure prophylaxis in Southern Africa: feasible or not?

J Int AIDS Soc. 2015-7-20

[4]
Defeating AIDS--advancing global health.

Lancet. 2015-7-11

[5]
The Epidemiology of HIV and Prevention Needs of Men Who Have Sex with Men in Abidjan, Cote d'Ivoire.

PLoS One. 2015-4-24

[6]
An urgent need for integration of family planning services into HIV care: the high burden of unplanned pregnancy, termination of pregnancy, and limited contraception use among female sex workers in Côte d'Ivoire.

J Acquir Immune Defic Syndr. 2015-3-1

[7]
Potential impact of existing interventions and of antiretroviral use in female sex workers on transmission of HIV in Burkina Faso: a modeling study.

J Acquir Immune Defic Syndr. 2015-3-1

[8]
Buffering Syndemic Effects in a Sexual Risk-Reduction Intervention for Male Clients of Female Sex Workers: Results From a Randomized Controlled Trial.

Am J Public Health. 2015-9

[9]
Risk Factors for HIV Acquisition in High Risk Women in a Generalised Epidemic Setting.

AIDS Behav. 2015-7

[10]
Cost-effectiveness of HIV prevention for high-risk groups at scale: an economic evaluation of the Avahan programme in south India.

Lancet Glob Health. 2014-8-27

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