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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<author><name sortKey="Klein, Daniel J" sort="Klein, Daniel J" uniqKey="Klein D" first="Daniel J." last="Klein">Daniel J. Klein</name>
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<author><name sortKey="Eckhoff, Philip A" sort="Eckhoff, Philip A" uniqKey="Eckhoff P" first="Philip A." last="Eckhoff">Philip A. Eckhoff</name>
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<author><name sortKey="Bershteyn, Anna" sort="Bershteyn, Anna" uniqKey="Bershteyn A" first="Anna" last="Bershteyn">Anna Bershteyn</name>
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<author><name sortKey="Klein, Daniel J" sort="Klein, Daniel J" uniqKey="Klein D" first="Daniel J." last="Klein">Daniel J. Klein</name>
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<author><name sortKey="Eckhoff, Philip A" sort="Eckhoff, Philip A" uniqKey="Eckhoff P" first="Philip A." last="Eckhoff">Philip A. Eckhoff</name>
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<series><title level="j">International Health</title>
<idno type="ISSN">1876-3413</idno>
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<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. However, migrant-targeted interventions synergize with general-population expansion of HIV services.</p>
</sec>
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