Strengthening the HIV prevention cascade to maximise epidemiological impact in eastern Zimbabwe: a modelling study.
Strengthening the HIV prevention cascade to maximise epidemiological impact in eastern Zimbabwe: a modelling study.
复制标题
加强艾滋病毒预防级联，最大限度地提高津巴布韦东部的流行病学影响：一项模型研究。
DOI：
10.1016/s2214-109x(23)00206-1
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Nyamukapa,Con
中科院分区：
文献类型：
--
作者：
Pickles,Michael;Gregson,Simon;Moorhouse,Louisa;Dadirai,Tawanda;Dzamatira,Freedom;Mandizvidza,Phyllis;Maswera,Rufurwokuda;Museka,Tafadzwa;Schaefer,Robin;Skovdal,Morten;Thomas,Ranjeeta;Tsenesa,Blessing;Mugurungi,Owen;Nyamukapa,Con
背景艾滋病毒预防级联提供了对预防障碍的系统理解。在这项研究中，我们使用数学建模来了解这些障碍的后果，以及如何级联可以加强，以最大限度地提高流行病学的影响，提供潜在的重要见解programmes.MethodsWe使用了一个基于个人的艾滋病毒传播模型（PopART-IBM），校准的数据从津巴布韦东部的马尼卡兰队列。从这个队列的艾滋病毒预防级联估计被用来作为概率的模型中的指标，代表个人的动机，访问和能力，有效地使用暴露前预防，自愿男性包皮环切术和避孕套。我们研究了与无障碍情景相比，目前的障碍如何影响艾滋病毒感染的数量和分布。使用关于干预措施如何加强艾滋病毒预防级联的假设，我们估计了通过解决级联的不同要素在10年内减少艾滋病毒感染的情况。结果由于现有的艾滋病毒预防级联障碍，未来10年将发生21200例新的潜在可避免的艾滋病毒感染，其中74.2%的28500例新感染将发生在约120万成年人的现有障碍中。 消除这些障碍将使艾滋病毒发病率降至消除流行病的基准以下。在一个优先人群中解决所有级联步骤比在所有人群中解决一个步骤要有效得多。InterpretationInterventions存在于津巴布韦东部，以减少艾滋病毒的消除，但动机，获取和有效使用的障碍，防止其充分发挥作用。干预措施必须是多层次的，涉及艾滋病毒预防工作的所有沿着步骤。纳入艾滋病毒预防级联的模型可以帮助确定提高有效性的主要障碍。资助国家精神卫生研究所、比尔和梅林达盖茨基金会和医学研究理事会全球传染病分析中心，由英国医学研究理事会和英国外交、联邦和发展办公室（FCDO）资助。
BackgroundHIV prevention cascades provide a systematic understanding of barriers to prevention. In this study we used mathematical modelling to understand the consequences of these barriers and how the cascade could be strengthened to maximise epidemiological impact, providing potentially important insights for programmes.MethodsWe used an individual-based model of HIV transmission (PopART-IBM), calibrated to data from the Manicaland cohort from eastern Zimbabwe. HIV prevention cascade estimates from this cohort were used as probabilities for indicators in the model representing an individual's motivation, access, and capacity to effectively use pre-exposure prophylaxis, voluntary male medical circumcision, and condoms. We examined how current barriers affect the number and distribution of HIV infections compared with a no-barrier scenario. Using assumptions about how interventions could strengthen the HIV prevention cascade, we estimated the reduction in HIV infections over a 10-year period through addressing different elements of the cascade.Findings21 200 new potentially avertable HIV infections will occur over the next 10 years due to existing HIV prevention cascade barriers, 74·2% of the 28 500 new infections that would occur with existing barriers in a population of approximately 1·2 million adults. Removing these barriers would reduce HIV incidence below the benchmarks for epidemic elimination. Addressing all cascade steps in one priority population is substantially more effective than addressing one step across all populations.InterpretationInterventions exist in eastern Zimbabwe to reduce HIV towards elimination, but barriers of motivation, access, and effective use prevent their full effect being realised. Interventions need to be multilayered and address all steps along the HIV prevention cascade. Models incorporating the HIV prevention cascade can help to identify the main barriers to greater effectiveness.FundingNational Institutes of Mental Health, Bill & Melinda Gates Foundation, and Medical Research Council Centre for Global Infectious Disease Analysis funding from the UK Medical Research Council and UK Foreign, Commonwealth & Development Office (FCDO).