Ruggles Kelly V, Patel Anik R, Schensul Stephen, Schensul Jean, Nucifora Kimberly, Zhou Qinlian, Bryant Kendall, Braithwaite R Scott
Department of Medicine, New York University School of Medicine, New York, NY, United States of America.
Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
PLoS One. 2017 Sep 5;12(9):e0184179. doi: 10.1371/journal.pone.0184179. eCollection 2017.
To inform the design of a combination intervention strategy targeting HIV-infected unhealthy alcohol users in Maharashtra, India, that could be tested in future randomized control trials.
Using probabilistic compartmental simulation modeling we compared intervention strategies targeting HIV-infected unhealthy alcohol users on antiretroviral therapy (ART) in Maharashtra, India. We tested interventions targeting four behaviors (unhealthy alcohol consumption, risky sexual behavior, depression and antiretroviral adherence), in three formats (individual, group based, community) and two durations (shorter versus longer). A total of 5,386 possible intervention combinations were tested across the population for a 20-year time horizon and intervention bundles were narrowed down based on incremental cost-effectiveness analysis using a two-step probabilistic uncertainty analysis approach.
Taking into account uncertainty in transmission variables and intervention cost and effectiveness values, we were able to reduce the number of possible intervention combinations to be used in a randomized control trial from over 5,000 to less than 5. The most robust intervention bundle identified was a combination of three interventions: long individual alcohol counseling; weekly Short Message Service (SMS) adherence counseling; and brief sex risk group counseling.
In addition to guiding policy design, simulation modeling of HIV transmission can be used as a preparatory step to trial design, offering a method for intervention pre-selection at a reduced cost.
为印度马哈拉施特拉邦针对感染艾滋病毒的不健康饮酒者设计一种联合干预策略，以便在未来的随机对照试验中进行测试。
我们使用概率性分区模拟模型，比较了印度马哈拉施特拉邦针对接受抗逆转录病毒治疗（ART）的感染艾滋病毒的不健康饮酒者的干预策略。我们测试了针对四种行为（不健康饮酒、危险性行为、抑郁和抗逆转录病毒治疗依从性）的干预措施，有三种形式（个体、基于小组、社区）和两种持续时间（较短与较长）。在20年的时间跨度内，对整个人口中总共5386种可能的干预组合进行了测试，并使用两步概率不确定性分析方法，基于增量成本效益分析缩小了干预组合范围。
考虑到传播变量以及干预成本和效果值的不确定性，我们能够将随机对照试验中可能使用的干预组合数量从5000多个减少到不到5个。确定的最有效的干预组合是三种干预措施的组合：长期个体酒精咨询；每周短信依从性咨询；以及简短的性风险群体咨询。
除了指导政策设计外，艾滋病毒传播的模拟模型还可作为试验设计的准备步骤，提供一种以较低成本进行干预预筛选的方法。
