Dynamics of the HIV outbreak and response in Scott County, IN, USA, 2011-15: a modelling study.
Dynamics of the HIV outbreak and response in Scott County, IN, USA, 2011-15: a modelling study.
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2011 - 15年，美国斯科特县的艾滋病毒爆发和反应动态：一项建模研究。
DOI：
10.1016/s2352-3018(18)30176-0
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发表时间：
2018-10
期刊：
影响因子：
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通讯作者：
Crawford FW
中科院分区：
文献类型：
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作者：
Gonsalves GS;Crawford FW
2014年11月，在印第安纳州斯科特县的注射毒品者中发现了一群艾滋病毒感染者，最终共有215例艾滋病毒感染归因于疫情。这项研究探讨了早期实施公共卫生应对措施是否会减少疫情的规模。我们每周从疫情中获得病例数据，并从印第安纳州CDC和研究人员公开的疫情报告中获得艾滋病毒检测、治疗和预防服务的情况。我们通过从CDC研究的已发表图像中数字提取数据，计算累积HIV发病率的上限和下限，该研究使用Bio-Rad亲合力发病率测试来估计每个传播事件的近度。利用这些公开可用的信息，我们构建了一个推广的易感染性去除模型，以捕捉艾滋病毒爆发的传播动力学。我们计算了未确诊的HIV感染人数的非参数区间估计值，每个未确诊的HIV感染的病例发现率，以及整个流行病期间HIV传播率的基于模型的界限。这使我们能够评估早期实施疫情应对措施的潜在影响。斯科特县未确诊艾滋病毒感染的上限在2015年1月10日左右达到高峰，有126例未确诊病例，比2015年3月26日州长彭斯宣布公共卫生紧急状态早了两个多月。将观察到的病例发现率扩大适用于较早的干预时间表明，较早的公共卫生应对措施本可以大大减少艾滋病毒感染的总人数。如果在2013年1月启动应对措施，感染总数将减少到56例以下，即至少避免了127例感染，而如果在2011年4月采取干预措施，感染总数将减少到10例以下，即至少避免了173例感染。早期和强有力的监测工作和病例发现本身就可以遏制新生的流行病。确保获得艾滋病毒服务和减少危害干预措施可以进一步降低爆发的可能性，并更大程度地减轻其严重性和范围。这项研究由美国国立精神卫生研究院，美国国立药物滥用研究所，美国国立卫生研究院大数据到知识（BD 2K）和NIH主任的新创新者奖计划资助。
In November 2014, a cluster of HIV infections was detected among people who inject drugs in Scott County, Indiana, with a total of 215 HIV infections eventually attributed to the outbreak. This study examines whether earlier implementation of a public health response would have diminished the scale of the outbreak. We derived weekly case data from the outbreak and on the uptake of HIV testing, treatment and prevention services from publicly available reports on the outbreak from CDC and researchers in Indiana. We computed upper and lower bounds for cumulative HIV incidence by digitally extracting data from published images from a CDC study using a Bio-Rad avidity incidence testing to estimate the recency of each transmission event. Using this publicly available information, we constructed a generalization of the susceptible-infectious-removed model to capture the transmission dynamics of the HIV outbreak. We computed nonparametric interval estimates of the number of undiagnosed HIV infections, the case-finding rate per undiagnosed HIV infection, and model-based bounds for the HIV transmission rate throughout the epidemic. This allowed us to assess the potential impact of earlier implementation of a response to the outbreak. The upper bound for undiagnosed HIV infections in Scott County peaked around January 10, 2015 at 126 undiagnosed cases, over two months before Governor Pence declared a public health emergency on March 26, 2015. Applying the observed case-finding rate scale-up to earlier intervention times suggests that an earlier public health response could have substantially reduced the total number of HIV infections. Initiation of a response in January 2013 would have suppressed the total number of infections to fewer than 56, representing at least 127 infections averted, while an intervention in April 2011 could have reduced the number of infections to fewer than ten, representing at least 173 infections averted. Early and robust surveillance efforts and case finding alone could blunt nascent epidemics. Ensuring access to HIV services and harm reduction interventions could further reduce the likelihood of outbreaks, and more substantially mitigate their severity and scope. This study was funded by the National Institutes of Mental Health, the National Institute on Drug Abuse, the National Institutes of Health Big Data to Knowledge (BD2K) and the NIH Director’s New Innovator Award programs.