Using geospatial modelling to optimize the rollout of antiretroviral-based pre-exposure HIV interventions in Sub-Saharan Africa
Using geospatial modelling to optimize the rollout of antiretroviral-based pre-exposure HIV interventions in Sub-Saharan Africa
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DOI：
10.1038/ncomms6454
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发表时间：
2014-12-01
影响因子：
16.6
通讯作者：
Blower, Sally
中科院分区：
文献类型：
--
作者：
Gerberry, David J.;Wagner, Bradley G.;Blower, Sally
基于抗逆转录病毒（ARV）的艾滋病毒暴露前干预措施可能很快就会在资源有限的撒哈拉以南非洲国家推出，但推出计划尚未设计。在这里，我们使用地理空间建模和优化技术来比较南非基于抗逆转录病毒药物的杀菌剂的两种推广计划：一种是利用地理定位来最大限度地减少发病率的功利主义计划，另一种是最大限度地提高干预措施的地理公平性的平等主义计划。我们发现减少艾滋病毒传播的干预措施的效率存在显着的地理差异，并且效率随着发病率的增加而不成比例地增加。功利主义计划将导致在获得干预措施方面存在相当大的地理不平等，但（通过利用发病率的地理差异）可以比平等主义计划多预防大约 40% 的感染。我们的结果表明，在推广开始时做出的地理资源分配决策以及推广开始的地点对于确定减少艾滋病毒流行的干预措施是否成功至关重要。
Antiretroviral (ARV)-based pre-exposure HIV interventions may soon be rolled out in resource-constrained Sub-Saharan African countries, but rollout plans have yet to be designed. Here we use geospatial modelling and optimization techniques to compare two rollout plans for ARV-based microbicides in South Africa: a utilitarian plan that minimizes incidence by using geographic targeting, and an egalitarian plan that maximizes geographic equity in access to interventions. We find significant geographic variation in the efficiency of interventions in reducing HIV transmission, and that efficiency increases disproportionately with increasing incidence. The utilitarian plan would result in considerable geographic inequity in access to interventions, but (by exploiting geographic variation in incidence) could prevent similar to 40% more infections than the egalitarian plan. Our results show that the geographic resource allocation decisions made at the beginning of a rollout, and the location where the rollout is initiated, will be crucial in determining the success of interventions in reducing HIV epidemics.