What is the achievable effectiveness of the India AIDS Initiative intervention among female sex workers under target coverage? Model projections from southern India
What is the achievable effectiveness of the India AIDS Initiative intervention among female sex workers under target coverage? Model projections from southern India
复制标题
DOI：
10.1136/sti.2006.020875
复制
发表时间：
2006-10-01
影响因子：
3.6
通讯作者：
Boily, M-C
中科院分区：
文献类型：
--
作者：
Williams, J. R.;Foss, A. M.;Boily, M-C
背景资料：由比尔和梅林达盖茨基金会资助的印度艾滋病倡议（Avahan）预防方案旨在降低艾滋病毒在高风险群体（如男女性工作者及其客户）中的流行率，以限制艾滋病毒在一般人群中的传播。Objectives：To assess the potential effectiveness of the Avahan intervention at the level of coverage targeted，in different epidemiological settings in India.方法：采用艾滋病毒和两种性传播感染传播动力学的确定性房室模型和敏感性分析技术，结合印度卡纳塔克邦迈索尔和巴加尔科特地区的现有行为和流行病学数据，评价综合征性传播感染（STI）管理（性传播感染治疗）、性传播感染的定期推定治疗（PPT）以及针对女性性工作者（FSW）的Avahan干预措施中的安全套组成部分。如果干预措施的所有组成部分都达到目标覆盖率（即PPT、性传播感染治疗和避孕套使用），在迈索尔这样的低传播环境中，该干预措施预计将在5年内预防FSW和总人口中22-35%的新艾滋病毒感染，并且在高传输设置（例如Bagalkot）中只有一半有效。结果对干预覆盖率的微小变化很敏感。预计在迈索尔，仅避孕套部分就可在5年内预防约20%的新艾滋病毒感染，仅性传播感染部分可预防约6%的新艾滋病毒感染;而仅PPT部分可预防7%-14%的新艾滋病毒感染。多变量敏感性分析表明，干预措施可能是更有效的设置与低FSW艾滋病毒流行率和小FSW人口，而艾滋病毒流行率的影响最大的性行为和安全套使用参数FSW.Conclusion：Avahan干预预计是有效的。然而，为了能够在不同的环境中以经验证明有效性，必须实现目标覆盖率或更高，就PPT而言，这可能需要数年时间才能实现。这些初步的模型预测需要用更详细的数学模型加以验证，因为在方案实施过程中，关于性行为、安全套使用、性传播感染和艾滋病毒趋势的数据会越来越好，干预措施覆盖率数据也会越来越多。
Background: The India AIDS Initiative (Avahan) prevention programme funded by the Bill and Melinda Gates Foundation aims to reduce HIV prevalence in high risk groups such as female and male sex workers and their clients, to limit HIV transmission in the general population.Objectives: To assess the potential effectiveness of the Avahan intervention at the level of coverage targeted, in different epidemiological settings in India.Methods: A deterministic compartmental model of the transmission dynamics of HIV and two sexually transmitted infections, and sensitivity analysis techniques, were used, in combination with available behavioural and epidemiological data from Mysore and Bagalkot districts in the Indian state of Karnataka, to evaluate the syndromic sexually transmitted infection (STI) management (STI treatment), periodic presumptive treatment of STI (PPT), and condom components of the Avahan intervention targeted to female sex workers (FSW).Results: If all components of the intervention reach target coverage (that is, PPT, STI treatment and condom use), the intervention is expected to prevent 22-35% of all new HIV infections in FSW and in the total population over 5 years in a low transmission setting like Mysore, and to be half as effective in high transmission settings such as Bagalkot. The results were sensitive to small variations in intervention coverage. The condom component alone is expected to prevent around 20% of all new HIV infections over 5 years in Mysore and around 6% for the STI component alone; compared with 7%-14% for the PPT component alone. Multivariate sensitivity analyses suggested that interventions may be more effective in settings with low FSW HIV prevalence and small FSW populations, whereas HIV prevalence was most influenced by sexual behaviour and condom use parameters for FSW.Conclusion: The Avahan intervention is expected to be effective. However, to be able to demonstrate effectiveness empirically in the different settings, it is important to achieve target coverage or higher, which in the case of PPT could take a number of years to achieve. These preliminary model predictions need to be validated with more detailed mathematical models, as better data on sexual behaviour, condom use, STI and HIV trends over time, and intervention coverage data accumulate over the course of the programme.