肯尼亚西部高危人群的流动性对艾滋病毒传播的影响。
The influence of mobility among high-risk populations on HIV transmission in Western Kenya.
作者信息
Bershteyn Anna, Mutai Kennedy K, Akullian Adam N, Klein Daniel J, Jewell Britta L, Mwalili Samuel M
机构信息
Institute for Disease Modeling, 3150 139 Ave. SE, Bellevue, WA 98005, USA.
National Aids Control Council, P.O. Box 61307-00200, Argwings Kodhek Rd, Nairobi, Kenya.
出版信息
Infect Dis Model. 2018 Apr 23;3:97-106. doi: 10.1016/j.idm.2018.04.001. eCollection 2018.
Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus (HIV). Although female sex workers (FSW) and their male clients are known to be at high risk for HIV, HIV prevalence across regions in Western Kenya is not strongly correlated with the fraction of women engaged in commercial sex. An agent-based network model of HIV transmission, geographically stratified at the county level, was fit to the HIV epidemic, scale-up of interventions, and populations of FSW in Western Kenya under two assumptions about the potential mobility of FSW clients. In the first, all clients were assumed to be resident in the same geographies as their interactions with FSW. In the second, some clients were considered non-resident and engaged only in interactions with FSW, but not in longer-term non-FSW partnerships in these geographies. Under both assumptions, the model successfully reconciled disparate geographic patterns of FSW and HIV prevalence. Transmission patterns in the model suggest a greater role for FSW in local transmission when clients were resident to the counties, with 30.0% of local HIV transmissions attributable to current and former FSW and clients, compared to 21.9% when mobility of clients was included. Nonetheless, the overall epidemic drivers remained similar, with risky behavior in the general population dominating transmission in high-prevalence counties. Our modeling suggests that co-location of high-risk populations and generalized epidemics can further amplify the spread of HIV, but that large numbers of formal FSW and clients are not required to observe or mechanistically explain high HIV prevalence in the general population.
肯尼亚西部遭受着人类免疫缺陷病毒(HIV)的高度地方性流行,且疫情非常不均衡。虽然已知女性性工作者(FSW)及其男性客户感染HIV的风险很高,但肯尼亚西部各地区的HIV流行率与从事商业性交易的女性比例并无强烈关联。在关于FSW客户潜在流动性的两种假设下,一个基于主体的HIV传播网络模型(按县进行地理分层)被用于拟合肯尼亚西部的HIV疫情、干预措施的扩大以及FSW人群情况。第一种假设是,所有客户都被假定居住在与他们和FSW发生互动的相同地区。第二种假设是,一些客户被视为非本地居民,仅与FSW发生互动,而不在这些地区建立长期的非FSW伙伴关系。在这两种假设下,该模型成功地调和了FSW和HIV流行率不同的地理模式。模型中的传播模式表明,当客户居住在各县时,FSW在本地传播中发挥了更大作用,30.0%的本地HIV传播可归因于现任和前任FSW及其客户,而纳入客户流动性时这一比例为21.9%。尽管如此,总体疫情驱动因素仍然相似,高流行率县的传播主要由普通人群中的危险行为主导。我们的模型表明,高危人群的聚集和广泛流行会进一步加剧HIV的传播,但并不需要大量正规的FSW及其客户来观察或从机制上解释普通人群中高HIV流行率的现象。
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