The rise and fall of HIV in high-prevalence countries: a challenge for mathematical modeling.
The rise and fall of HIV in high-prevalence countries: a challenge for mathematical modeling.
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DOI：
10.1371/journal.pcbi.1003459
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发表时间：
2014-03
影响因子：
4.3
通讯作者：
de Vlas SJ
中科院分区：
文献类型：
--
作者：
Nagelkerke NJ;Arora P;Jha P;Williams B;McKinnon L;de Vlas SJ
艾滋病毒普遍高流行的几个国家，主要是在撒哈拉以南非洲，传播率迅速下降。这些艾滋病毒流行通常会迅速发作，通常被归因于与高危性行为有关的多种因素的组合。这些国家随后的下降在广泛治疗或实施任何其他重大生物医学预防之前就开始了。这种变化被解释为行为变化的证据，通常基于数学模型，但解释这些下降的行为变化的直接证据是有限的。在这里，我们考察了当前模型的结构，并认为常见的“每次性接触的固定风险”假设倾向于得出实质性行为变化的结论。我们认为，这一假设忽略了暴露与风险之间报告的非线性。考虑到这一点，我们提出，艾滋病毒传播的一些下降可能是流行病自然动态的一部分，而且由于缺乏准确的定量估计，传统上被建模人员忽略的几个因素很可能是理解流行病学趋势的关键。
Several countries with generalized, high-prevalence HIV epidemics, mostly in sub-Saharan Africa, have experienced rapid declines in transmission. These HIV epidemics, often with rapid onsets, have generally been attributed to a combination of factors related to high-risk sexual behavior. The subsequent declines in these countries began prior to widespread therapy or implementation of any other major biomedical prevention. This change has been construed as evidence of behavior change, often on the basis of mathematical models, but direct evidence for behavior changes that would explain these declines is limited. Here, we look at the structure of current models and argue that the common “fixed risk per sexual contact" assumption favors the conclusion of substantial behavior changes. We argue that this assumption ignores reported non-linearities between exposure and risk. Taking this into account, we propose that some of the decline in HIV transmission may be part of the natural dynamics of the epidemic, and that several factors that have traditionally been ignored by modelers for lack of precise quantitative estimates may well hold the key to understanding epidemiologic trends.
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DOI：
10.1097/00126334-200405010-00010
发表时间：
2004-05-01
影响因子：
3.6
作者：
Auvert, B;Males, S;Williams, B
通讯作者：
Williams, B
影响因子：
17.1
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Partners in Prevention HSV/HIV Transmission Study Team
DOI：
10.7196/samj.4672
发表时间：
2011-01-01
期刊：
SAMJ: South African Medical Journal
影响因子：
--
作者：
Bateman, Chris
通讯作者：
Bateman, Chris
DOI：
10.1097/qad.0b013e32833424c8
发表时间：
2010-01-16
期刊：
AIDS (London, England)
影响因子：
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作者：
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通讯作者：
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影响因子：
158.5
作者：
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通讯作者：
DEWIT, S