Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data.
Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data.
复制标题
DOI：
10.1016/s0140-6736(12)61960-6
复制
发表时间：
2013-05-04
期刊：
影响因子：
168.9
通讯作者：
Dushoff, Jonathan
中科院分区：
文献类型：
--
作者：
Bellan, Steve E.;Fiorella, Kathryn J.;Melesse, Dessalegn Y.;Getz, Wayne M.;Williams, Brian G.;Dushoff, Jonathan
在撒哈拉以南非洲，异性艾滋病毒传播中发生在同居伴侣关系中的比例，而不是发生在单身人士之间，或发生在夫妇外关系中，这是一个积极辩论的主题。这个问题具有直接的重要性。随着使用抗逆转录病毒药物作为人口一级预防战略的计划取得进展，了解不同传播途径的重要性对于有针对性的干预工作至关重要。我们使用人口与健康调查的数据建立了一个HIV传播机制模型，该数据涵盖了来自18个撒哈拉以南非洲国家的27，201对同居夫妇，并提供了有关夫妇持续时间，首次性行为年龄和HIV血清状态的信息。我们将该模型与艾滋病毒存活时间的估计值以及艾滋病毒流行率和ART覆盖率的国家特定估计值相结合。然后，我们估计了在调查的同居夫妇中观察到的感染比例，这些感染发生在夫妇形成之前，夫妇成员之间，以及通过夫妇外性交。我们估计，在接受调查的夫妇中，夫妇外传播分别占所有感染男性和女性的27-61%和21-51%，给出的范围反映了国家间的差异。我们预计，在未来一年，在同居夫妇中，夫妇外传播将分别占男性和女性艾滋病毒新感染病例的30-65%和10-47%。我们的研究结果还表明，夫妇之间的传播方向主要是从男性到女性，然而，女性在夫妇形成之前经历了一个非常高的风险期。由于夫妇外传播的贡献很大，艾滋病毒预防干预措施应针对一般性活跃人口，而不仅仅是血清不一致的夫妇。
The proportion of heterosexual HIV transmission in Sub-Saharan Africa that occurs within cohabiting partnerships, as opposed to among single people, or in extra-couple relationships, is a subject of active debate. This question is of immediate importance. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is critical to targeting intervention efforts. We built a mechanistic HIV transmission model using data from Demographic and Health Surveys covering 27,201 cohabiting couples from 18 sub-Saharan African countries with information on couple duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and ART coverage. We then estimated the proportion of observed infections in surveyed cohabiting couples that occurred prior to couple formation, between couple members, and through extra-couple intercourse. We estimate that extra-couple transmission accounts for between 27-61% and 21-51% of all infected males and females, respectively, in surveyed couples, with the ranges given reflecting inter-country variation. We project that over the next year extra-couple transmission will account for 30-65% and 10-47% of new incident HIV infections in males and females, respectively, in cohabiting couples. Our results also suggest that the directionality of transmission within couples is largely from males to females; however, females experience a very high-risk period prior to couple formation. Due to the large contribution of extra-couple transmission, HIV prevention interventions should target the general sexually active population, and not just serodiscordant couples.