Improving the Validity of Mathematical Models for HIV Elimination by Incorporating Empirical Estimates of Progression Through the HIV Treatment Cascade
Improving the Validity of Mathematical Models for HIV Elimination by Incorporating Empirical Estimates of Progression Through the HIV Treatment Cascade
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DOI：
10.1097/qai.0000000000001852
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发表时间：
2018-12-15
影响因子：
3.6
通讯作者：
Salomon, Joshua A.
中科院分区：
文献类型：
--
作者：
Chang, Angela Y.;Haber, Noah;Salomon, Joshua A.
背景资料：通过扩大抗逆转录病毒治疗消除艾滋病毒的前景乐观，部分是由于几项数学建模研究的预测。根据对整个艾滋病毒护理级联过程中进展率的详细实证评估，我们首次量化了当模型未能纳入对级联的现实理解时，模型可能高估政策变化带来的健康益处的程度。设置：农村夸祖鲁-纳塔尔，南非。方法：我们使用来自夸祖鲁-纳塔尔农村地区基于人群的纵向艾滋病监测系统的数据，估计了艾滋病治疗级联各阶段的进展率。通过对HIV进展、感染传播和护理的数学模型进行实证估计，我们估计了在一系列治疗规模扩大的情况下避免的预期寿命和继发感染，这些情况反映了扩大治疗资格阈值。我们比较了结果与传统的假设，已普遍采用现有models.Results：生存增益扩大治疗资格阈值从CD 4 350-500细胞/mL和从500细胞/mL治疗每个人，无论他们的CD 4计数可能被高估的3.60和3.79倍的模型，未能捕捉现实的护理级联。艾滋病毒感染避免从提高阈值从CD 4 200到350，350到500，和500细胞/毫升治疗每个人可能被高估1.10，2.65，和1.18倍，分别：模型使用传统的假设级联进展可能大大高估了健康的好处。随着扩大治疗工作的开展，必须评估所需扩大治疗工作的效果，同时考虑到人们如何通过艾滋病毒级联传播的经验现实。
Background: Optimism regarding prospects for eliminating HIV by expanding antiretroviral treatment has been emboldened in part by projections from several mathematical modeling studies. Drawing from a detailed empirical assessment of rates of progression through the entire HIV care cascade, we quantify for the first time the extent to which models may overestimate health benefits from policy changes when they fail to incorporate a realistic understanding of the cascade.Setting: Rural KwaZulu-Natal, South Africa.Methods: We estimated rates of progression through stages of the HIV treatment cascade using data from a longitudinal population-based HIV surveillance system in rural KwaZulu-Natal. Incorporating empirical estimates in a mathematical model of HIV progression, infection transmission, and care, we estimated life expectancy and secondary infections averted under a range of treatment scale-up scenarios reflecting expanding treatment eligibility thresholds. We compared the results with those implied by the conventional assumptions that have been commonly adopted by existing models.Results: Survival gains from expanding the treatment eligibility threshold from CD4 350-500 cells/mL and from 500 cells/mL to treating everyone irrespective of their CD4 count may be overestimated by 3.60 and 3.79 times in models that fail to capture realities of the care cascade. HIV infections averted from raising the threshold from CD4 200 to 350, 350 to 500, and 500 cells/mL to treating everyone may be overestimated by 1.10, 2.65, and 1.18 times, respectively.Conclusions: Models using conventional assumptions about cascade progression may substantially overestimate health benefits. As implementation of treatment scale-up proceeds, it is important to assess the effects of required scale-up efforts in a way that incorporates empirical realities of how people move through the HIV cascade.