Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics in their home communities: a mathematical modeling analysis
Identifieur interne : 001367 ( Main/Curation ); précédent : 001366; suivant : 001368Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics in their home communities: a mathematical modeling analysis
Auteurs : Daniel J. Klein ; Philip A. Eckhoff ; Anna BershteynSource :
- International Health [ 1876-3413 ] ; 2015.
Abstract
Migrant populations such as mine workers contributed to the spread of HIV in sub-Saharan Africa. We used a mathematical model to estimate the community-wide impact of targeting treatment and prevention to male migrants.
We augmented an individual-based network model, EMOD-HIV v0.8, to include an age-dependent propensity for males to migrate. Migrants were exposed to HIV outside their home community, but continued to participate in HIV transmission in the community during periodic visits.
Migrant-targeted interventions would have been transformative in the 1980s to 1990s, but post-2015 impacts were more modest. When targetable migrants comprised 2% of adult males, workplace HIV prevention averted 3.5% of community-wide infections over 20 years. Targeted treatment averted 8.5% of all-cause deaths among migrants. When migrants comprised 10% of males, workplace prevention averted 16.2% of infections in the community, one-quarter of which were among migrants. Workplace prevention and treatment acted synergistically, averting 17.1% of community infections and 11.6% of deaths among migrants. These estimates do not include prevention of secondary spread of HIV or tuberculosis at the workplace.
Though cost-effective, targeting migrants cannot collapse generalized epidemics in their home communities. Such a strategy would only have been possible prior to the early 1990s. However, migrant-targeted interventions synergize with general-population expansion of HIV services.
Url:
DOI: 10.1093/inthealth/ihv011
PubMed: 25733560
PubMed Central: 4379985
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics in their home communities: a mathematical modeling analysis</title><author><name sortKey="Klein, Daniel J" sort="Klein, Daniel J" uniqKey="Klein D" first="Daniel J." last="Klein">Daniel J. Klein</name></author><author><name sortKey="Eckhoff, Philip A" sort="Eckhoff, Philip A" uniqKey="Eckhoff P" first="Philip A." last="Eckhoff">Philip A. Eckhoff</name></author><author><name sortKey="Bershteyn, Anna" sort="Bershteyn, Anna" uniqKey="Bershteyn A" first="Anna" last="Bershteyn">Anna Bershteyn</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25733560</idno><idno type="pmc">4379985</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379985</idno><idno type="RBID">PMC:4379985</idno><idno type="doi">10.1093/inthealth/ihv011</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000101</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000101</idno><idno type="wicri:Area/Pmc/Curation">000101</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000101</idno><idno type="wicri:Area/Pmc/Checkpoint">000A23</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000A23</idno><idno type="wicri:Area/Ncbi/Merge">002E81</idno><idno type="wicri:Area/Ncbi/Curation">002E81</idno><idno type="wicri:Area/Ncbi/Checkpoint">002E81</idno><idno type="wicri:doubleKey">1876-3413:2015:Klein D:targeting:hiv:services</idno><idno type="wicri:Area/Main/Merge">001368</idno><idno type="wicri:Area/Main/Curation">001367</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics in their home communities: a mathematical modeling analysis</title><author><name sortKey="Klein, Daniel J" sort="Klein, Daniel J" uniqKey="Klein D" first="Daniel J." last="Klein">Daniel J. Klein</name></author><author><name sortKey="Eckhoff, Philip A" sort="Eckhoff, Philip A" uniqKey="Eckhoff P" first="Philip A." last="Eckhoff">Philip A. Eckhoff</name></author><author><name sortKey="Bershteyn, Anna" sort="Bershteyn, Anna" uniqKey="Bershteyn A" first="Anna" last="Bershteyn">Anna Bershteyn</name></author></analytic><series><title level="j">International Health</title><idno type="ISSN">1876-3413</idno><idno type="eISSN">1876-3405</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Migrant populations such as mine workers contributed to the spread of HIV in sub-Saharan Africa. We used a mathematical model to estimate the community-wide impact of targeting treatment and prevention to male migrants.</p></sec><sec><title>Methods</title><p>We augmented an individual-based network model, EMOD-HIV v0.8, to include an age-dependent propensity for males to migrate. Migrants were exposed to HIV outside their home community, but continued to participate in HIV transmission in the community during periodic visits.</p></sec><sec><title>Results</title><p>Migrant-targeted interventions would have been transformative in the 1980s to 1990s, but post-2015 impacts were more modest. When targetable migrants comprised 2% of adult males, workplace HIV prevention averted 3.5% of community-wide infections over 20 years. Targeted treatment averted 8.5% of all-cause deaths among migrants. When migrants comprised 10% of males, workplace prevention averted 16.2% of infections in the community, one-quarter of which were among migrants. Workplace prevention and treatment acted synergistically, averting 17.1% of community infections and 11.6% of deaths among migrants. These estimates do not include prevention of secondary spread of HIV or tuberculosis at the workplace.</p></sec><sec><title>Conclusions</title><p>Though cost-effective, targeting migrants cannot collapse generalized epidemics in their home communities. Such a strategy would only have been possible prior to the early 1990s. 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