Changing Dynamics of HIV Transmission in Cote d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015)
Changing Dynamics of HIV Transmission in Cote d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015)
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DOI：
10.1097/qai.0000000000001434
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发表时间：
2017-08-15
影响因子：
3.6
通讯作者：
Boily, Marie-Claude
中科院分区：
文献类型：
--
作者：
Maheu-Giroux, Mathieu;Vesga, Juan F.;Boily, Marie-Claude
导言：了解过去干预措施的影响及其如何影响传播动态是指导预防工作的关键。我们估计了避孕套、抗逆转录病毒治疗（ART）和预防母婴传播活动对艾滋病毒传播的人口水平影响，以及艾滋病毒获取和传播的关键危险因素的贡献。方法：对普通人群、女性性工作者（FSW）和男男性行为者之间的性传播和垂直传播的年龄分层动态模型进行校准，以获得详细的患病率和干预数据。我们估计了通过干预措施避免的艾滋病毒感染的比例，以及在连续10年期间（1976-2015）不同人群获得和传播的事件感染的比例。结果：总体而言，1987-2015年期间，安全套的使用避免了61%（95%可信区间：56%-66%）的成人感染，主要原因是性服务性伴侣使用增加（避免了46%的感染）。相比之下，在2010-2015年期间，抗逆转录病毒治疗预防了15%（10%-19%）的成人感染。因此，FSW最初（1976-1985年）占所有新感染的95%(91%-97%)，在2005-2015年期间下降到19%（11%-27%）。老年男性和嫖客与非fsw混杂在一起是目前传播的最高贡献者。与男性发生性关系的男性也有贡献
Introduction: Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission.Methods: An age-stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015).Results: Overall, condom use averted 61% (95% credible intervals: 56%-66%) of all adult infections during 1987-2015 mainly because of increased use by FSW (46% of infections averted). In comparison, ART prevented 15% (10%-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91%-97%) of all new infections, declining to 19% (11%-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributors to transmission. Men who have sex with men contributed