Maximising the effect of combination HIV prevention through prioritisation of the people and places in greatest need: a modelling study
Maximising the effect of combination HIV prevention through prioritisation of the people and places in greatest need: a modelling study
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DOI：
10.1016/s0140-6736(14)61053-9
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发表时间：
2014-07-19
期刊：
影响因子：
168.9
通讯作者：
Hallett, Timothy B.
中科院分区：
文献类型：
--
作者：
Anderson, Sarah-Jane;Cherutich, Peter;Hallett, Timothy B.
背景流行病学数据显示，非洲国家不同社区感染艾滋病毒的风险有很大差异。我们假设，将适当的干预措施集中在艾滋病毒感染的高危地区和关键人群上，可以改善艾滋病毒应对投资的效果。方法以肯尼亚为例，我们建立了一个数学模型，描述了艾滋病毒流行的时空演变，并纳入了不同国家单位的人口、行为和规划差异。可根据不同人群的危险行为或所在地区，向不同人群提供模式化干预措施(男性包皮环切术、行为改变交流、早期抗逆转录病毒治疗和暴露前预防)。对于给定的国家预算，我们比较了在全国范围内提供相同数量的干预措施的统一干预战略的效果，以及定制干预措施集和分配给当地流行病情况的资源的重点战略的效果。发现统一分布的艾滋病毒预防干预措施组合可以在15年内将新感染艾滋病毒的总数减少40%。在没有额外支出的情况下，这一效果可以在15年内增加14%--几乎增加10万例新感染病例，如果采用有重点的办法来调整资源分配，以反映当地流行病学的模式，到这段时期结束时，每年发生的新艾滋病毒感染病例将减少33%。在15年预测期内，新感染病例的累积差异取决于总预算和干预成本，在不同的干预单位成本假设下，累积差异可能高达15万(累积差异高达22%)。解释：在完全相同的投资下，重点方法比统一方法取得更大的效果。通过对感染风险最大的人和地点进行优先排序，并调整干预措施以反映当地的流行病学情况，重点做法可以大大提高艾滋病毒预防投资的效率和效力。
Background Epidemiological data show substantial variation in the risk of HIV infection between communities within African countries. We hypothesised that focusing appropriate interventions on geographies and key populations at high risk of HIV infection could improve the effect of investments in the HIV response.Methods With use of Kenya as a case study, we developed a mathematical model that described the spatiotemporal evolution of the HIV epidemic and that incorporated the demographic, behavioural, and programmatic differences across subnational units. Modelled interventions (male circumcision, behaviour change communication, early antiretoviral therapy, and pre-exposure prophylaxis) could be provided to different population groups according to their risk behaviours or their location. For a given national budget, we compared the effect of a uniform intervention strategy, in which the same complement of interventions is provided across the country, with a focused strategy that tailors the set of interventions and amount of resources allocated to the local epidemiological conditions.Findings A uniformly distributed combination of HIV prevention interventions could reduce the total number of new HIV infections by 40% during a 15-year period. With no additional spending, this effect could be increased by 14% during the 15 years-almost 100 000 extra infections, and result in 33% fewer new HIV infections occurring every year by the end of the period if the focused approach is used to tailor resource allocation to reflect patterns in local epidemiology. The cumulative difference in new infections during the 15-year projection period depends on total budget and costs of interventions, and could be as great as 150 000 (a cumulative difference as great as 22%) under different assumptions about the unit costs of intervention.Interpretation The focused approach achieves greater effect than the uniform approach despite exactly the same investment. Through prioritisation of the people and locations at greatest risk of infection, and adaption of the interventions to reflect the local epidemiological context, the focused approach could substantially increase the efficiency and effectiveness of investments in HIV prevention.