Modeling dynamic interactions between pre-exposure prophylaxis interventions & treatment programs: predicting HIV transmission & resistance.

Modeling dynamic interactions between pre-exposure prophylaxis interventions & treatment programs: predicting HIV transmission & resistance.
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DOI:
10.1038/srep00185
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发表时间:
2011
期刊:
影响因子:
4.6
通讯作者:
Blower, Sally
Blower, Sally
中科院分区:
综合性期刊3区
文献类型:
--
作者:
Supervie, Virginie;Barrett, Meagan;Kahn, James S.;Musuka, Godfrey;Moeti, Themba Lebogang;Busang, Lesogo;Blower, Sally

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最近的临床试验证明了暴露前预防 (PrEP) 在预防 HIV 感染方面的有效性。因此,PrEP 可能很快就会用于流行病控制。我们对资源有限国家的治疗计划和潜在 PrEP 干预措施之间发生的动态相互作用进行了建模。我们确定艾滋病毒传播和耐药性的后果。我们使用响应超曲面模型来预测 PrEP 对减少传播的影响,作为有效性、依从性和覆盖范围的函数。我们预测 PrEP 将增加未经治疗的个体对二线疗法 (SLT) 的需求,但可能显着减少有治疗经验的个体对 SLT 的需求。如果仔细规划 PrEP 的推出,可以提高治疗计划的可持续性。否则,对 SLT 的需求可能会增加,治疗计划的可持续性可能会受到损害。我们的结果表明,在资源有限的国家推出 PrEP 的最佳策略是从“最差”的治疗计划开始。
Clinical trials have recently demonstrated the effectiveness of Pre-Exposure Prophylaxis (PrEP) in preventing HIV infection. Consequently, PrEP may soon be used for epidemic control. We model the dynamic interactions that will occur between treatment programs and potential PrEP interventions in resource-constrained countries. We determine the consequences for HIV transmission and drug resistance. We use response hypersurface modeling to predict the effect of PrEP on decreasing transmission as a function of effectiveness, adherence and coverage. We predict PrEP will increase need for second-line therapies (SLT) for treatment-naïve individuals, but could significantly decrease need for SLT for treatment-experienced individuals. If the rollout of PrEP is carefully planned it could increase the sustainability of treatment programs. If not, need for SLT could increase and the sustainability of treatment programs could be compromised. Our results show the optimal strategy for rolling out PrEP in resource-constrained countries is to begin around the “worst” treatment programs.
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