Assessing evidence for behaviour change affecting the course of HIV epidemics: A new mathematical modelling approach and application to data from Zimbabwe
Assessing evidence for behaviour change affecting the course of HIV epidemics: A new mathematical modelling approach and application to data from Zimbabwe
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DOI：
10.1016/j.epidem.2009.03.001
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发表时间：
2009-06-01
期刊：
影响因子：
3.8
通讯作者：
Garnett, Geoff P.
中科院分区：
文献类型：
--
作者：
Hallett, Timothy B.;Gregson, Simon;Garnett, Geoff P.
背景资料：确定减少艾滋病毒传播的干预措施是否有效至关重要，但由于普遍流行病可能随着时间的推移而演变，而个人不改变风险行为，这一点变得复杂。我们的目的是开发一种方法，以评估证据的风险行为改变的过程中的HIV epidemies.Methods的变化：我们开发了一个数学模型的HIV传播，将潜在的自然变化的流行病，因为它的成熟和抗逆转录病毒治疗的引入，并应用贝叶斯融合框架，在该模型和观察到的流行趋势可以进行比较。我们将该模型应用到津巴布韦，使用艾滋病毒流行率估计产前诊所监测和家庭为基础的调查，并基于模型参数的数据从性行为surveys.Results：有强有力的证据减少艾滋病毒传播的风险行为。我们估计这些变化发生在1999年和2004年之间，到2008年避免了660，000例（95%可信区间：460，000 - 860，000）感染。讨论：该模型和相关的分析框架提供了一个强大的方法来评估影响HIV流行过程的风险行为变化的证据，避免了HIV流行的自然演变的混淆。(C)2009 Elsevier Inc. All rights reserved.
Background: Determining whether interventions to reduce HIV transmission have worked is essential, but complicated by the potential for generalised epidemics to evolve over time without individuals changing risk behaviour. We aimed to develop a method to evaluate evidence for changes in risk behaviour altering the course of an HIV epidemic.Methods: We developed a mathematical model of HIV transmission, incorporating the potential for natural changes in the epidemic as it matures and the introduction of antiretroviral treatment, and applied a Bayesian Melding framework, in which the model and observed trends in prevalence can be compared. We applied the model to Zimbabwe, using HIV prevalence estimates from antenatal clinic surveillance and house-hold based surveys, and basing model parameters on data from sexual behaviour surveys.Results: There was strong evidence for reductions in risk behaviour stemming HIV transmission. We estimate these changes occurred between 1999 and 2004 and averted 660,000 (95% credible interval: 460,000-860,000) infections by 2008.Discussion: The model and associated analysis framework provide a robust way to evaluate the evidence for changes in risk behaviour affecting the course of HIV epidemics, avoiding confounding by the natural evolution of HIV epidemics. (C) 2009 Elsevier Inc. All rights reserved.