Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission
Identifieur interne : 000107 ( PascalFrancis/Curation ); précédent : 000106; suivant : 000108Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission
Auteurs : Wafaa M. El-Sadr [États-Unis] ; Brian J. Coburn [États-Unis] ; Sally Blower [États-Unis]Source :
- AIDS : (London) [ 0269-9370 ] ; 2011.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Background: The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART). Objective: To predict the epidemic impact of treating HIV-discordant couples to prevent transmission. Design: Mathematical modeling to predict incidence reduction and the number of infections prevented. Methods: Demographic and epidemiological data from Ghana, Lesotho, Malawi and Rwanda were used to parameterize the model. ART was assumed to be 96% effective in preventing transmission. Results: Our results show there would be a fairly large reduction in incidence and a substantial number of infections prevented in Malawi. However, in Ghana a large number of infections would be prevented, but only a small reduction in incidence. Notably, the predicted number of infections prevented would be similar (and low) in Lesotho and Rwanda, but incidence reduction would be substantially greater in Lesotho than Rwanda. The higher the proportion of the population in stable partnerships (whether concordant or discordant), the greater the effect of a discordant couple's intervention on HIV epidemics. Conclusion: The effectiveness of a discordant couples intervention in reducing incidence will vary among countries due to differences in HIV prevalence and the percentage of couples that are discordant (i.e. degree of discordancy). The number of infections prevented within a country, as a result of an intervention, will depend upon a complex interaction among three factors: population size, HIV prevalence and degree of discordancy. Our model provides a quantitative framework for identifying countries most likely to benefit from treating discordant couples to prevent transmission.
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Coburn</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Blower, Sally" sort="Blower, Sally" uniqKey="Blower S" first="Sally" last="Blower">Sally Blower</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">12-0043381</idno><date when="2011">2011</date><idno type="stanalyst">PASCAL 12-0043381 INIST</idno><idno type="RBID">Pascal:12-0043381</idno><idno type="wicri:Area/PascalFrancis/Corpus">000022</idno><idno type="wicri:Area/PascalFrancis/Curation">000107</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission</title><author><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>ICAP, Mailman School of Public Health, Department of Epidemiology and Medicine at Columbia University, New York</s1><s2>New York</s2><s3>USA</s3><sZ>1 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Coburn, Brian J" sort="Coburn, Brian J" uniqKey="Coburn B" first="Brian J." last="Coburn">Brian J. Coburn</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Blower, Sally" sort="Blower, Sally" uniqKey="Blower S" first="Sally" last="Blower">Sally Blower</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author></analytic><series><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">AIDS : (London)</title><title level="j" type="abbreviated">AIDS : (Lond.)</title><idno type="ISSN">0269-9370</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Antiretroviral agent</term><term>Antiviral</term><term>Chemotherapy</term><term>Human immunodeficiency virus</term><term>Mathematical model</term><term>Modeling</term><term>Prevention</term><term>Transmission</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term><term>Antiviral</term><term>Chimiothérapie</term><term>Modélisation</term><term>Antirétroviral</term><term>Virus immunodéficience humaine</term><term>Prévention</term><term>Transmission</term><term>Modèle mathématique</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART). Objective: To predict the epidemic impact of treating HIV-discordant couples to prevent transmission. Design: Mathematical modeling to predict incidence reduction and the number of infections prevented. Methods: Demographic and epidemiological data from Ghana, Lesotho, Malawi and Rwanda were used to parameterize the model. ART was assumed to be 96% effective in preventing transmission. Results: Our results show there would be a fairly large reduction in incidence and a substantial number of infections prevented in Malawi. However, in Ghana a large number of infections would be prevented, but only a small reduction in incidence. Notably, the predicted number of infections prevented would be similar (and low) in Lesotho and Rwanda, but incidence reduction would be substantially greater in Lesotho than Rwanda. The higher the proportion of the population in stable partnerships (whether concordant or discordant), the greater the effect of a discordant couple's intervention on HIV epidemics. Conclusion: The effectiveness of a discordant couples intervention in reducing incidence will vary among countries due to differences in HIV prevalence and the percentage of couples that are discordant (i.e. degree of discordancy). The number of infections prevented within a country, as a result of an intervention, will depend upon a complex interaction among three factors: population size, HIV prevalence and degree of discordancy. Our model provides a quantitative framework for identifying countries most likely to benefit from treating discordant couples to prevent transmission.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0269-9370</s0></fA01><fA03 i2="1"><s0>AIDS : (Lond.)</s0></fA03><fA05><s2>25</s2></fA05><fA06><s2>18</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission</s1></fA08><fA11 i1="01" i2="1"><s1>EL-SADR (Wafaa M.)</s1></fA11><fA11 i1="02" i2="1"><s1>COBURN (Brian J.)</s1></fA11><fA11 i1="03" i2="1"><s1>BLOWER (Sally)</s1></fA11><fA14 i1="01"><s1>ICAP, Mailman School of Public Health, Department of Epidemiology and Medicine at Columbia University, New York</s1><s2>New York</s2><s3>USA</s3><sZ>1 aut.</sZ></fA14><fA14 i1="02"><s1>Center for Biomedical Modeling, University of California David Geffen School of Medicine</s1><s2>Los Angeles, California</s2><s3>USA</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ></fA14><fA20><s1>2295-2299</s1></fA20><fA21><s1>2011</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>22094</s2><s5>354000505984410120</s5></fA43><fA44><s0>0000</s0><s1>© 2012 INIST-CNRS. 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However, in Ghana a large number of infections would be prevented, but only a small reduction in incidence. Notably, the predicted number of infections prevented would be similar (and low) in Lesotho and Rwanda, but incidence reduction would be substantially greater in Lesotho than Rwanda. The higher the proportion of the population in stable partnerships (whether concordant or discordant), the greater the effect of a discordant couple's intervention on HIV epidemics. Conclusion: The effectiveness of a discordant couples intervention in reducing incidence will vary among countries due to differences in HIV prevalence and the percentage of couples that are discordant (i.e. degree of discordancy). The number of infections prevented within a country, as a result of an intervention, will depend upon a complex interaction among three factors: population size, HIV prevalence and degree of discordancy. 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