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Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission

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Modeling 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, England) [ 0269-9370 ] ; 2011.

RBID : PMC:4699795

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.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699795

DOI: 10.1097/QAD.0b013e32834c4c22
PubMed: 21993304
PubMed Central: 4699795

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<series><title level="j">AIDS (London, England)</title>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P2">The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART).</p>
</sec>
<sec id="S2"><title>Objective</title>
<p id="P3">To predict the epidemic impact of treating HIV-discordant couples to prevent transmission.</p>
</sec>
<sec id="S3"><title>Design</title>
<p id="P4">Mathematical modeling to predict incidence reduction and the number of infections prevented.</p>
</sec>
<sec id="S4"><title>Methods</title>
<p id="P5">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.</p>
</sec>
<sec id="S5"><title>Results</title>
<p id="P6">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.</p>
</sec>
<sec id="S6"><title>Conclusion</title>
<p id="P7">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.</p>
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  <front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id>
<journal-id journal-id-type="pubmed-jr-id">1493</journal-id>
<journal-id journal-id-type="nlm-ta">AIDS</journal-id>
<journal-id journal-id-type="iso-abbrev">AIDS</journal-id>
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<issn pub-type="ppub">0269-9370</issn>
<issn pub-type="epub">1473-5571</issn>
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<article-meta><article-id pub-id-type="pmid">21993304</article-id>
<article-id pub-id-type="pmc">4699795</article-id>
<article-id pub-id-type="doi">10.1097/QAD.0b013e32834c4c22</article-id>
<article-id pub-id-type="manuscript">NIHMS724794</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>El-Sadr</surname>
<given-names>Wafaa M.</given-names>
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<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="author-notes" rid="FN1">*</xref>
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<contrib contrib-type="author"><name><surname>Coburn</surname>
<given-names>Brian J.</given-names>
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<xref ref-type="aff" rid="A2">b</xref>
<xref ref-type="author-notes" rid="FN1">*</xref>
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<aff id="A1"><label>a</label>
ICAP, Mailman School of Public Health, Department of Epidemiology and Medicine at Columbia University, New York, New York</aff>
<aff id="A2"><label>b</label>
Center for Biomedical Modeling, University of California David Geffen School of Medicine, Los Angeles, California, USA</aff>
<author-notes><corresp id="CR1">Correspondence to Wafaa M. El-Sadr, MD, MPH, ICAP-Columbia University, Mailman School of Public Health, 722 West 168th Street, Room 1312, New York, NY 10032, USA. Tel: +1 212 342 0532; fax: +1 212 342 1824; <email>wme1@columbia.edu</email>
</corresp>
<fn fn-type="equal" id="FN1"><label>*</label>
<p id="P1">Wafaa M. El-Sadr and Brian J. Coburn contributed equally to this work.</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>25</day>
<month>9</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="ppub"><day>28</day>
<month>11</month>
<year>2011</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>04</day>
<month>1</month>
<year>2016</year>
</pub-date>
<volume>25</volume>
<issue>18</issue>
<fpage>2295</fpage>
<lpage>2299</lpage>
<pmc-comment>elocation-id from pubmed: 10.1097/QAD.0b013e32834c4c22</pmc-comment>
      <abstract><sec id="S1"><title>Background</title>
<p id="P2">The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART).</p>
</sec>
<sec id="S2"><title>Objective</title>
<p id="P3">To predict the epidemic impact of treating HIV-discordant couples to prevent transmission.</p>
</sec>
<sec id="S3"><title>Design</title>
<p id="P4">Mathematical modeling to predict incidence reduction and the number of infections prevented.</p>
</sec>
<sec id="S4"><title>Methods</title>
<p id="P5">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.</p>
</sec>
<sec id="S5"><title>Results</title>
<p id="P6">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.</p>
</sec>
<sec id="S6"><title>Conclusion</title>
<p id="P7">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.</p>
</sec>
</abstract>
<kwd-group><kwd>antiretroviral therapy</kwd>
<kwd>infections prevented</kwd>
<kwd>mathematical modeling</kwd>
<kwd>prevention of HIV transmission</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission

Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission

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