Impact of interventions targeting unhealthy alcohol use in Kenya on HIV transmission and AIDS-related deaths.
Impact of interventions targeting unhealthy alcohol use in Kenya on HIV transmission and AIDS-related deaths.
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DOI：
10.1111/acer.12332
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发表时间：
2014-04
期刊：
影响因子：
--
通讯作者：
Bryant K
中科院分区：
文献类型：
--
作者：
Braithwaite RS;Nucifora KA;Kessler J;Toohey C;Mentor SM;Uhler LM;Roberts MS;Bryant K
在肯尼亚，艾滋病毒仍然是可预防的发病和死亡的主要原因。伴随不健康饮酒的行为的影响是艾滋病毒传播和进展的普遍危险因素。我们的目标是估计部分艾滋病毒感染归因于不健康的酒精使用，并评估针对不健康的酒精使用的假设干预措施对艾滋病毒感染和死亡的影响。我们估计结果超过20年的时间跨度使用计算机模拟肯尼亚人口。这种计算机模拟将艾滋病毒传播的房室模型与先前在撒哈拉以南非洲验证的艾滋病毒进展的机制模型相结合。传播和进展模型的整合允许同时考虑酒精对艾滋病毒传播和进展的影响（例如，降低抗逆转录病毒依从性可能通过提高病毒载量而增加传播风险，并且可能同时通过增加AIDS的可能性而增加进展）。模拟考虑了异质性混合模式的重要方面，包括合作伙伴的年龄和活动水平，年龄不一致的关系，和高活动的亚组。结果包括新的艾滋病毒感染人数，艾滋病死亡人数和传染性（每年每个感染者的新感染人数）。我们的模型估计，伴随不健康饮酒的行为的影响是肯尼亚13.0%的新艾滋病毒感染的原因。一项酒精干预措施的有效性与肯尼亚一项基于认知行为疗法的干预措施的随机对照试验（减少45%的不健康酒精消费）相似，可以预防近一半的感染，在20年内减少69，858人，减少17，824人的艾滋病死亡。估计数对酒精对避孕套使用、抗逆转录病毒治疗依从性和性传播感染流行率的潜在影响程度的假设很敏感。在肯尼亚，大量新的艾滋病毒感染可归因于不健康的饮酒。在一项已发表的随机对照试验中观察到的有效性的酒精干预有可能在20年内将感染减少近5%，并避免近18，000例与艾滋病毒有关的死亡。
HIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths. We estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub-Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on HIV transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year). Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence. A substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to HIV.
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影响因子：
56.3
作者：
Boily, Marie-Claude;Baggaley, Rebecca F.;Wang, Lei;Masse, Benoit;White, Richard G.;Hayes, Richard J.;Alary, Michel
通讯作者：
Alary, Michel
影响因子：
3.8
作者：
Mbizvo, MT;Machekano, R;Katzenstein, D
通讯作者：
Katzenstein, D
影响因子：
3.8
作者：
Kalichman, Seth C.;Simbayi, Leickness C.;Jooste, Sean
通讯作者：
Jooste, Sean
DOI：
10.1097/01.qai.0000151079.33935.79
发表时间：
2005-08-01
影响因子：
3.6
作者：
Marks, G;Crepaz, N;Janssen, RS
通讯作者：
Janssen, RS
影响因子：
6
作者：
Braithwaite, R. Scott;Nucifora, Kimberly A.;Wools-Kaloustian, Kara
通讯作者：
Wools-Kaloustian, Kara