Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal.
Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal.
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DOI：
10.1002/jia2.25126
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发表时间：
2018-07
影响因子：
6
通讯作者：
Vickerman P
中科院分区：
文献类型：
--
作者：
Mukandavire C;Walker J;Schwartz S;Boily MC;Danon L;Lyons C;Diouf D;Liestman B;Diouf NL;Drame F;Coly K;Muhire RSM;Thiam S;Diallo PAN;Kane CT;Ndour C;Volz E;Mishra S;Baral S;Vickerman P
包括女性性工作者（FSW）和男男性行为者（MSM）在内的关键人群承受着不成比例的艾滋病毒负担。然而，将预防工作的重点放在这些群体对减少一个国家的艾滋病毒流行病的作用是有争议的。我们估计在多大程度上，艾滋病毒传播FSW和男男性接触者之间的贡献，在塞内加尔达喀尔的整体艾滋病毒传播，使用人口归因分数（PAF）的动态评估。使用1985年至2015年特定环境的人口统计学、行为、艾滋病毒流行病学和抗逆转录病毒治疗（ART）覆盖率数据，在贝叶斯框架内对FSW、其客户、MSM和低风险成年人群之间的艾滋病毒动态传播模型进行了参数化和校准。我们使用该模型估计了FSW与其客户之间的商业性行为以及男性之间的性行为对整体艾滋病毒传播的10年PAF（定义为当这些传播方式被删除时预防的新感染的百分比）。此外，我们估计了与安全套使用和ART吸收的历史增加相关的预防效益，以及进一步增加预防和治疗的影响。模型预测表明，1995年至2005年期间，男性之间的无保护性行为占传播的42%（2.5至97.5百分位数范围24%至59%），从2015年至2025年增加到64%（37%至79%）。商业性行为的10年PAF较小，从1995年的21%（7%至39%）下降到2015年的14%（5%至35%）。如果没有抗逆转录病毒疗法，自2000年开始抗逆转录病毒疗法以来，艾滋病毒感染率将增加49%（32%至71%），而自1985年以来，如果没有使用避孕套，艾滋病毒感染率将增加67%（27%至179%），艾滋病毒总体流行率将比现在高60%（29%至211%）。通过扩大抗逆转录病毒疗法在男男性行为者中的覆盖率至74%，并通过任何预防方式将其对艾滋病毒的易感性降低三分之二，可以进一步大幅降低艾滋病毒发病率（68%）。由于循证干预措施的覆盖面不够理想，男性之间无保护的性行为可能是达喀尔艾滋病毒传播的一个重要因素。虽然现有的干预措施有效地减少了艾滋病毒在成年人中的传播，但至关重要的是，进一步的战略要解决男男性行为者中未得到满足的需求。
Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). A dynamic transmission model of HIV among FSW, their clients, MSM and the lower‐risk adult population was parameterized and calibrated within a Bayesian framework using setting‐specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10‐year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10‐year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two‐thirds through any prevention modality. Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence‐informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.
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通讯作者：
ESSEX, M