The influence of mobility among high-risk populations on HIV transmission in Western Kenya
The influence of mobility among high-risk populations on HIV transmission in Western Kenya
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DOI：
10.1016/j.idm.2018.04.001
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发表时间：
2018-01-01
影响因子：
8.8
通讯作者：
Mwalili, Samuel M.
中科院分区：
文献类型：
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作者：
Bershteyn, Anna;Mutai, Kennedy K.;Mwalili, Samuel M.
肯尼亚西部是人类免疫缺陷病毒（HIV）的高度地方性和异质性的流行地区。尽管已知女性性工作者（FSW）及其男性客户是艾滋病毒的高危人群，但肯尼亚西部地区的艾滋病毒流行率与从事商业性行为的女性比例并没有很强的相关性。基于代理的艾滋病毒传播网络模型，在县一级进行地理分层，在关于FSW客户潜在流动性的两个假设下，适用于肯尼亚西部的艾滋病毒流行、干预措施的扩大和FSW人口。首先，假设所有客户与FSW交互时都居住在相同的地理位置。在第二种情况下，一些客户被认为是非居民，只与FSW进行互动，而不是这些地区的长期非FSW合作伙伴关系。在这两种假设下，该模型成功地协调了FSW和HIV流行的不同地理模式。模型中的传播模式表明，当客户居住在县时，FSW在当地传播中的作用更大，30.0%的当地艾滋病毒传播可归因于当前和以前的FSW和客户，而当客户包括流动性时，这一比例为21.9%。尽管如此，总体的流行病驱动因素仍然相似，在高流行县，普通人群的危险行为主导着传播。我们的模型表明，高风险人群和普遍流行病的共存可能进一步扩大艾滋病毒的传播，但不需要大量正式的FSW和客户观察或机械地解释普通人群中的高艾滋病毒流行率。(C) 2018年作者。由Elsevier B.V.代表KeAi Communications Co. Ltd制作和主持。
Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus (HIV). Although female sex workers (FSW) and their male clients are known to be at high risk for HIV, HIV prevalence across regions in Western Kenya is not strongly correlated with the fraction of women engaged in commercial sex. An agent-based network model of HIV transmission, geographically stratified at the county level, was fit to the HIV epidemic, scale-up of interventions, and populations of FSW in Western Kenya under two assumptions about the potential mobility of FSW clients. In the first, all clients were assumed to be resident in the same geographies as their interactions with FSW. In the second, some clients were considered non-resident and engaged only in interactions with FSW, but not in longer-term non-FSW partnerships in these geographies. Under both assumptions, the model successfully reconciled disparate geographic patterns of FSW and HIV prevalence. Transmission patterns in the model suggest a greater role for FSW in local transmission when clients were resident to the counties, with 30.0% of local HIV transmissions attributable to current and former FSW and clients, compared to 21.9% when mobility of clients was included. Nonetheless, the overall epidemic drivers remained similar, with risky behavior in the general population dominating transmission in high-prevalence counties. Our modeling suggests that co-location of high-risk populations and generalized epidemics can further amplify the spread of HIV, but that large numbers of formal FSW and clients are not required to observe or mechanistically explain high HIV prevalence in the general population. (C) 2018 The Authors. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.