HIV Epidemic Appraisals for Assisting in the Design of Effective Prevention Programmes: Shifting the Paradigm Back to Basics
HIV Epidemic Appraisals for Assisting in the Design of Effective Prevention Programmes: Shifting the Paradigm Back to Basics
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DOI：
10.1371/journal.pone.0032324
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发表时间：
2012-03-01
期刊：
影响因子：
3.7
通讯作者：
Blanchard, James F.
中科院分区：
文献类型：
--
作者：
Mishra, Sharmistha;Sgaier, Sema K.;Blanchard, James F.
背景资料：为了设计艾滋病毒预防方案，必须了解当地流行病的时间和地理方面，并解决导致艾滋病毒传播的关键行为。已经制定了两种方法来评估艾滋病毒的流行和指导预防战略。数字替代方法根据目前艾滋病毒流行率阈值对流行病进行分类。传播模式（MOT）模型估计了一年内风险群体之间的发病率分布。这两种方法都侧重于流行病的当前状态，并提供可能无法捕获流行病学驱动因素的短期指标。通过对国家和地方数据的详细分析，我们探讨了两种传统方法的局限性，并提出了一种替代approximates.Methods和Findings：我们比较了五个国家的传统方法的输出结果公布，并应用数字和MOT模型，印度和印度的六个地区。我们发现了当前流行病评估方法的三个局限性：（1）它们的结果未能识别驱动流行病的关键行为;（2）它们难以应用于地区一级行政单位之间具有异质性的地方流行病;（3）MOT模型对输入参数高度敏感，其中许多参数需要从非区域来源提取。我们开发了一种替代的决策树框架艾滋病毒流行病评估，基于定性的了解流行病学的驱动因素，并证明了其适用性在印度。替代框架提供了一个逻辑算法来表征流行病，它需要最少的，但关键的data.Conclusions：传统的评估，利用流行和事件的艾滋病毒感染的分布在短期内可能会误导预防的优先事项，并可能阻碍努力阻止艾滋病毒流行的轨迹。一种描述当地传播动态的方法提供了一种可能更有效的工具，决策者可以利用这种工具设计干预方案。
Background: To design HIV prevention programmes, it is critical to understand the temporal and geographic aspects of the local epidemic and to address the key behaviours that drive HIV transmission. Two methods have been developed to appraise HIV epidemics and guide prevention strategies. The numerical proxy method classifies epidemics based on current HIV prevalence thresholds. The Modes of Transmission (MOT) model estimates the distribution of incidence over one year among risk-groups. Both methods focus on the current state of an epidemic and provide short-term metrics which may not capture the epidemiologic drivers. Through a detailed analysis of country and sub-national data, we explore the limitations of the two traditional methods and propose an alternative approach.Methods and Findings: We compared outputs of the traditional methods in five countries for which results were published, and applied the numeric and MOT model to India and six districts within India. We discovered three limitations of the current methods for epidemic appraisal: (1) their results failed to identify the key behaviours that drive the epidemic; (2) they were difficult to apply to local epidemics with heterogeneity across district-level administrative units; and (3) the MOT model was highly sensitive to input parameters, many of which required extraction from non-regional sources. We developed an alternative decision-tree framework for HIV epidemic appraisals, based on a qualitative understanding of epidemiologic drivers, and demonstrated its applicability in India. The alternative framework offered a logical algorithm to characterize epidemics; it required minimal but key data.Conclusions: Traditional appraisals that utilize the distribution of prevalent and incident HIV infections in the short-term could misguide prevention priorities and potentially impede efforts to halt the trajectory of the HIV epidemic. An approach that characterizes local transmission dynamics provides a potentially more effective tool with which policy makers can design intervention programmes.