Modelling the epidemiological impact of scaling up HIV testing and antiretroviral treatment in China

Sexual Health ◽  
2012 ◽  
Vol 9 (3) ◽  
pp. 261 ◽  
Author(s):  
Lei Zhang ◽  
Richard T. Gray ◽  
David P. Wilson
Keyword(s):  
Hiv Testing ◽  
Action Plan ◽  
Scale Up ◽  
Hiv Infections ◽  
Fold Increase ◽  
Treatment Rate ◽  
Hiv Epidemic ◽  
Epidemiological Impact ◽  
Public Health Strategies ◽  
Roll Out

Background The HIV epidemic in China has been increasing. In response, a 5-year action plan in China has prioritised the scale-up of HIV testing and treatment. Methods: We use a mathematical model to reproduce HIV epidemic trends in China and to forecast epidemic trends according to current conditions or increases in the rate of HIV testing or roll-out of antiretroviral therapy. Results: We show that the epidemic in China could be expected to experience a 2.5-fold expansion over the next 5 years such that ~1.8 million people will be infected with HIV in China by 2015. However, increasing testing and treatment rates can have substantial epidemiological benefits. For example, a four-fold increase in testing rates may avert more than 42 000 HIV infections and 11 000 deaths over the next 5years. A 10-fold increase in the treatment rate could decrease the number of HIV-related deaths by 58% and the number of new infections by one-quarter by 2015. Conclusions: Increasing HIV testing and treatment are important public health strategies for prevention.

Could implementation of Australia's National Gay Men's Syphilis Action Plan have an indirect effect on the HIV epidemic?

Sexual Health ◽  
2012 ◽  
Vol 9 (2) ◽  
pp. 144 ◽  
Author(s):  
Alexander Hoare ◽  
Richard T. Gray ◽  
David P. Wilson
Keyword(s):  
Public Health ◽  
Gay Men ◽  
Indirect Effect ◽  
Hiv Transmission ◽  
Action Plan ◽  
Hiv Infections ◽  
Hiv Interventions ◽  
Sexually Transmissible Infections ◽  
Epidemiological Impact ◽  
Public Health Strategies

Objectives The number of incident infections of syphilis and HIV have increased over the past decade across Australia, particularly among gay men. In other industrialised settings, syphilis epidemics have also resurged coincidentally with increases in HIV diagnoses. Sexually transmissible infections (STI) are a biologically plausible cofactor for increasing HIV transmission. We pose the question: could strategies purely targeting syphilis also have an indirect impact on HIV incidence? Methods: We developed an agent-based computer model that simulates the transmission and disease progression of HIV and syphilis among a population of sexually active gay men, calibrated to reflect the epidemics in Victoria, Australia. The model was informed by detailed behavioural data from a variety of sources and was used to investigate the potential epidemiological impact of different public health interventions. Results: Assuming that syphilis could act as a biological cofactor for HIV transmission, from no effect to increasing risk by five-fold, our model indicates that if Australia’s syphilis action plan is effectively implemented then the number of HIV infections could decrease by up to 48% over the next decade in the absence of any specific HIV interventions. Conclusion: It is plausible that effective implementation of interventions targeting syphilis epidemics can have an indirect effect of mitigating the spread of HIV. The possible effects of STI should be considered in the design, implementation and evaluation of public health strategies and programs.

scholarly journals The impact of the program for medical male circumcision on HIV in South Africa: analysis using three epidemiological models

2021 ◽  
Vol 5 ◽  
pp. 15
Author(s):  
Eline L. Korenromp ◽  
Anna Bershteyn ◽  
Edina Mudimu ◽  
Renay Weiner ◽  
Collen Bonecwe ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Hiv Transmission ◽  
Scale Up ◽  
Household Survey ◽  
Hiv Infections ◽  
Treatment Needs ◽  
Medical Male Circumcision ◽  
Hiv Epidemic ◽  
The Impact

Background: South Africa began offering medical male circumcision (MMC) in 2010. We evaluated the current and future impact of this program to see if it is effective in preventing new HIV infections. Methods: The Thembisa, Goals and Epidemiological Modeling Software (EMOD) HIV transmission models were calibrated to South Africa’s HIV epidemic, fitting to household survey data on HIV prevalence, risk behaviors, and proportions of men circumcised, and to programmatic data on intervention roll-out including program-reported MMCs over 2009-2017. We compared the actual program accomplishments through 2017 and program targets through 2021 with a counterfactual scenario of no MMC program. Results: The MMC program averted 71,000-83,000 new HIV infections from 2010 to 2017. The future benefit of the circumcision already conducted will grow to 496,000-518,000 infections (6-7% of all new infections) by 2030. If program targets are met by 2021 the benefits will increase to 723,000-760,000 infections averted by 2030. The cost would be $1,070-1,220 per infection averted relative to no MMC. The savings from averted treatment needs would become larger than the costs of the MMC program around 2034-2039. In the Thembisa model, when modelling South Africa’s 9 provinces individually, the 9-provinces-aggregate results were similar to those of the single national model. Across provinces, projected long-term impacts were largest in Free State, KwaZulu-Natal and Mpumalanga (23-27% reduction over 2017-2030), reflecting these provinces’ greater MMC scale-up. Conclusions: MMC has already had a modest impact on HIV incidence in South Africa and can substantially impact South Africa’s HIV epidemic in the coming years.

Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men

Sexual Health ◽  
2009 ◽  
Vol 6 (1) ◽  
pp. 19 ◽  
Author(s):  
David P. Wilson ◽  
Alexander Hoare ◽  
David G. Regan ◽  
Matthew G. Law
Keyword(s):  
Hiv Testing ◽  
Early Treatment ◽  
Hiv Transmission ◽  
Public Health Intervention ◽  
Population Level ◽  
Hiv Infections ◽  
Long Term Effects ◽  
Wide Range ◽  
Epidemiological Impact ◽  
Sex With Men

Background: We address the research questions: (i) what proportion of new HIV infections is transmitted from people who are (a) undiagnosed, (b) in primary HIV infection (PHI), (c) on antiretroviral therapy?; and (ii) what is the expected epidemiological impact of (a) increasing the proportion of newly acquired HIV infections receiving early treatment, and (b) increasing HIV testing rates? Methods: We used a mathematical model to simulate HIV transmission in the population of men who have sex with men (MSM) in Australia. We calibrated the model using established biological and clinical data and a wide range of Australian MSM epidemiological and behavioural data sources. Results: We estimate that ~19% of all new HIV infections are transmitted from the ~3% of Australian HIV-infected MSM who are in PHI; ~31% of new HIV infections are estimated to be transmitted from the ~9% of MSM with undiagnosed HIV. We estimate that the average number of infections caused per HIV-infected MSM through the duration of PHI is ~0.14–0.28. Conclusions: The epidemiological impact of increasing treatment in PHI would be modest due to insufficient detection of newly-infected individuals. In contrast, increases in HIV testing rates could have substantial epidemiological consequences. The benefit of testing will also increase over time. Promoting increases in the coverage and frequency of testing for HIV could be a highly-effective public health intervention, but the population-level impact of interventions based on promoting early treatment of patients diagnosed in PHI is likely to be small. Treating PHI requires further evaluation of its long-term effects on HIV-infected individuals.

scholarly journals Integration of HIV and sexual and reproductive health in the era of anti-retroviral-based prevention: findings from assessments in Kenya, Malawi and Zimbabwe

2021 ◽  
Vol 5 ◽  
pp. 145
Author(s):  
Fannie Kachale ◽  
Imelda Mahaka ◽  
Fatima Mhuriro ◽  
Mary Mugambi ◽  
Joseph Murungu ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Reproductive Health ◽  
Program Implementation ◽  
Sexual And Reproductive Health ◽  
Scale Up ◽  
Hiv Infections ◽  
Sub Saharan Africa ◽  
Structural Factors ◽  
Hiv Epidemic ◽  
Key Informant

Background: Though substantial progress has been made to curb the HIV epidemic, high rates of new HIV infections persist among adolescent girls and young women (AGYW) in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and sexual and reproductive health (SRH) services. With the scale-up of oral pre-exposure prophylaxis (PrEP) and multiple novel HIV prevention products on the horizon, countries have a unique opportunity to expand innovative approaches to deliver comprehensive, integrated HIV/SRH services. Methods: This article is a comparative analysis of findings from rapid landscaping analyses in Kenya, Malawi and Zimbabwe to highlight cross-country trends and context-specific realities around HIV/SRH integration. The analyses in Kenya and Zimbabwe were completed by Ministries of Health (MOH) and the HIV Prevention Market Manager project and include 20 health facility assessments, 73 key informant interviews and six community dialogues. In Malawi, the analysis was completed by the MOH and Georgetown University Center for Innovation in Global Health and includes 70 key informant interviews and a review of national policies and program implementation in Blantyre. Findings were validated through a review of literature and policies in each country. Results: The policy environment in all three countries is conducive to HIV/SRH integration, though operationalization continues to present challenges, with most policies preceding and not accounting for oral PrEP rollout. National coordination mechanisms, youth-friendly health services and prevention of mother-to-child transmission programs are promising practices, while siloed and resource-constrained health systems, limited provider capacity, lack of support for demand generation and structural factors exacerbate barriers to achieving integration. Conclusions: As new HIV prevention products are introduced, demand for integrated HIV/SRH services is likely to grow. Investing in HIV/SRH integration can help to ensure sustainable, government-led responses to the HIV epidemic, streamline service delivery and improve the health outcomes and lives of AGYW.

A Continuing HIV Epidemic and Differential Patterns of HIV-STI Risk among MSM in Quito, Ecuador: An Urgent Need to Scale Up HIV Testing and Prevention

2013 ◽  
Vol 18 (1) ◽  
pp. 88-98 ◽  
Author(s):  
Jerry O. Jacobson ◽  
Amaya Sánchez-Gómez ◽  
Orlando Montoya ◽  
Efrain Soria ◽  
Wilmer Tarupi ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Scale Up ◽  
Hiv Epidemic

scholarly journals High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study

2017 ◽  
Vol 72 (2) ◽  
pp. 168-172 ◽  
Author(s):  
Alain Vandormael ◽  
Tulio de Oliveira ◽  
Frank Tanser ◽  
Till Bärnighausen ◽  
Joshua T Herbeck
Keyword(s):  
Hiv Testing ◽  
South African ◽  
Hiv Infections ◽  
Population Based ◽  
Hiv Positive ◽  
Aids Epidemic ◽  
Undiagnosed Hiv ◽  
African Community ◽  
Repeat Hiv Testing ◽  
High Level

BackgroundUndiagnosed HIV infections could undermine efforts to reverse the global AIDS epidemic by 2030. In this study, we estimated the percentage of HIV-positive persons who remain undiagnosed within a hyperendemic South African community.MethodsThe data come from a population-based surveillance system located in the Umkhanyakude district of the northern KwaZulu-Natal province, South Africa. We annually tested 38 661 adults for HIV between 2005 and 2016. Using the HIV-positive test results of 12 039 (31%) participants, we then back-calculated the incidence of infection and derived the number of undiagnosed cases from this result.ResultsThe percentage of undiagnosed HIV cases decreased from 29.3% in 2005 to 15.8% in 2011. During this period, however, approximately 50% of the participants refused to test for HIV, which lengthened the average time from infection to diagnosis. Consequently, the percentage of undiagnosed HIV cases reversed direction and steadily increased from 16.1% to 18.9% over the 2012–2016 period.ConclusionsResults from this hyperendemic South African setting show that the HIV testing rate is low, with long infection times, and an unsatisfactorily high percentage of undiagnosed cases. A high level of repeat HIV testing is needed to minimise the time from infection to diagnosis if the global AIDS epidemic is to be reversed within the next two decades.

scholarly journals Cost-Effectiveness of Peer-Delivered HIV Self-Tests for MSM in Uganda

2021 ◽  
Vol 9 ◽  
Author(s):  
Stephen Okoboi ◽  
Barbara Castelnuovo ◽  
Jean-Pierre Van Geertruyden ◽  
Oucul Lazarus ◽  
Lung Vu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hiv Testing ◽  
Cost Effective ◽  
Hiv Infections ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
High Risk Population ◽  
Self Testing ◽  
The Cost

Introduction: Distribution of HIV self-testing (HIVST) kits through MSM peer networks is a novel and effective strategy to increase HIV testing coverage in this high-risk population. No study has evaluated the cost or cost effectiveness of peer distribution of HIVST strategies among MSM in sub-Saharan Africa.Methods: From June to August 2018, we conducted a pilot study of secondary MSM peer HIVST kit distribution at The AIDS Support Organization at Entebbe and Masaka. We used an ingredients approach to estimate the cost of MSM peer HIVST kit distribution relative to standard-of-care (SOC) hotspot testing using programme expenditure data reported in US dollars. The provider perspective was used to estimate incremental cost-effective ratios per HIV infection averted using the difference in HIV annual transmission rates between MSM with HIV who knew their status and were not virologically suppressed and MSM with HIV who did not know their status.Results: We enrolled 297 participants of whom 150 received MSM peer HIVST kit distribution (intervention group) and 147 received TASO standard of care HIV testing (control group). Provider cost for the intervention was $2,276 compared with $1,827 for SOC during the 3-month study period. Overall, the intervention resulted in higher HIV positivity yield (4.9 vs. 1.4%) and averted more HIV infections per quarter (0.364 vs. 0.104) compared with SOC. The cost per person tested was higher for the intervention compared to SOC ($15.90 vs. $12.40). Importantly, the cost per new HIV diagnosis ($325 vs. $914) and cost per transmission averted ($6,253 vs. $ 17,567) were lower for the intervention approach relative to SOC. The incremental cost per HIV transmission averted by the self-testing program was $1,727. The incremental cost to providers per additional HIV-positive person identified by the intervention was $147.30.Conclusion: The intervention strategy was cost-effective, and identified more undiagnosed HIV infections than SOC hotspot testing at a cost-effectiveness threshold of US $2,129. Secondary distribution of HIVST kits through peers should further be evaluated with longer duration aimed at diagnosing 95% of all persons with HIV by 2030; the first UNAIDS 95-95-95 target.

scholarly journals Business and Human Rights in ASEAN: Lessons from the Palm Oil Sector in Malaysia

2019 ◽  
Vol 7 (1) ◽  
pp. 73
Author(s):  
Andika AB. Wahab
Keyword(s):  
Human Rights ◽  
Corporate Culture ◽  
Palm Oil ◽  
Action Plan ◽  
Scale Up ◽  
Member States ◽  
Oil Companies ◽  
Business And Human Rights ◽  
Asean Member ◽  
Guiding Principles

The release of the United Nations Guiding Principles on Business and Human Rights in 2011 aims to address gaps in human rights governance by setting a standard and corporate culture of respecting human rights. As part of the state responsibility to implement these guiding principles, some member states of the Association of Southeast Asian Nations (ASEAN) have already embarked preliminary steps towards establishing their respective National Action Plan on Business and Human rights (NAPBHR), while others are still lag behind. This article describes current development on business and human rights in the region. Drawing from the palm oil sector’s experience in Malaysia, this study aims to provide lessons for ASEAN member states to contemplate when developing their NAPBHR. In this article, I argue that while some large palm oil companies have shown modest progress in realizing their human rights obligation, challenges emerge in many forms including the lack of leadership, collaboration and ambition to steer and scale up industry transformation on human rights across supply chain. Equally important, challenges around certification scheme depict that it is not the only solution in persuading respect to human rights. Meaningful values transfer often overlooked in certification practice resulting in typical "ticking the audit box" exercise without understanding principles behind it. As such, the development of NAPBHR among the ASEAN member states should reflect on these reality and challenges.

HIV testing in Acute Care

2018 ◽  
Vol 17 (2) ◽  
pp. 61-61
Author(s):  
Pippa J Newton ◽  
Keyword(s):  
Health Care ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Health Care Services ◽  
Hiv Infections ◽  
Late Presentation ◽  
Care Services ◽  
Undiagnosed Hiv ◽  
The Usa ◽  
Number Of Individuals

Readers may be aware of the need to improve uptake of HIV testing in health care-settings to reduce the number of individuals with undiagnosed infection who later present with advanced disease. Late presentation of HIV infection is associated with a poorer immune response to antiretroviral therapy, an increased morbidity and mortality with a resultant higher cost burden to health-care services. Individuals with undiagnosed HIV infection who inadvertently transmit their infection to others are thought to be responsible for more than half of new HIV infections in the USA.

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