Interuniversity Institute for Biostatistics and Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Hasselt, Belgium.
International AIDS Vaccine Initiative, Nairobi, Kenya.
BMC Infect Dis. 2023 Mar 22;23(1):173. doi: 10.1186/s12879-023-08113-2.
In countries with mature generalized HIV epidemics such as Uganda, there are still groups of individuals that are disproportionately affected. Among the key populations in Uganda are fishing communities, which make up about 10% of the population. Compared to the general population, HIV prevalence and incidence among individuals living in these communities is high. This high HIV burden has been attributed to several factors including limited access to prevention and treatment services as well as ongoing high-risk sexual behaviour.
We investigated the impact of combined HIV prevention interventions on HIV transmission dynamics in high-risk fishing communities in Uganda using a deterministic compartmental model. The model was calibrated to seroprevalence data from a census performed in 2014. To account for remaining uncertainty in the calibrated model parameters, 50 000 simulated scenarios were modelled to investigate the impact of combined prevention interventions.
The projected HIV incidence decreased from 1.87 per 100 PY without intervention scale-up to 0.25 per 100 PY after 15 years (2014-2029) of intervention scale-up. A potential combination achieving this 87% reduction in incidence over 15 years in Ugandan FCs included condom use in about 60% of sexual acts, 23% of susceptible men circumcised, 87% of people living with HIV aware of their status, 75% of those on ART, and about 3% of susceptible individuals on oral PrEP. Uncertainty analysis revealed relative reductions in incidence ranging from 30.9 to 86.8%. Sensitivity analyses suggested that condom use and early ART were the most important interventions.
Reducing HIV incidence, as well as prevalence and AIDS-related mortality, in these high-risk fishing communities in Uganda is attainable over 15 years with a combination prevention package. Our projected intervention coverage levels are well within the national targets set by the Uganda government and enable coming close to reaching the UNAIDS 95-95-95 targets to end AIDS as a public health threat by 2030.
在乌干达等拥有成熟普遍 HIV 流行的国家，仍有一些人群受到不成比例的影响。乌干达的重点人群包括渔业社区，占总人口的 10%左右。与一般人群相比，生活在这些社区的个体 HIV 流行率和发病率较高。这种高 HIV 负担归因于多种因素，包括获得预防和治疗服务的机会有限以及持续的高危性行为。
我们使用确定性房室模型研究了在乌干达高危渔业社区联合 HIV 预防干预措施对 HIV 传播动态的影响。该模型根据 2014 年进行的普查血清阳性率数据进行了校准。为了考虑校准模型参数中仍然存在的不确定性，对 50000 个模拟情景进行了建模，以调查联合预防干预措施的影响。
在没有扩大干预措施的情况下，预计 HIV 发病率从每 100 人年 1.87 例降至干预措施扩大 15 年后的每 100 人年 0.25 例（2014-2029 年）。在乌干达 FC 中，实现这一 15 年内发病率降低 87%的潜在综合措施包括：约 60%的性行为中使用安全套，23%的易感染男性行包皮环切术，87%的 HIV 感染者知晓自身状况，75%的接受 ART 治疗者，以及约 3%的易感染个体服用口服 PrEP。不确定性分析显示，发病率相对降低幅度在 30.9%至 86.8%之间。敏感性分析表明，安全套使用和早期 ART 是最重要的干预措施。
在乌干达这些高危渔业社区，通过综合预防方案，在 15 年内降低 HIV 发病率以及流行率和艾滋病相关死亡率是可以实现的。我们预测的干预覆盖水平远低于乌干达政府设定的国家目标，这使我们能够接近实现到 2030 年实现联合国艾滋病规划署 95-95-95 目标，即终结艾滋病作为公共卫生威胁。
