scholarly journals Predicting HIV Incidence in the SEARCH Trial: A Mathematical Modelling Study

2018 ◽  
Author(s):  
Britta L. Jewell ◽  
Anna Bershteyn
Keyword(s):  
Male Circumcision ◽  
Viral Suppression ◽  
Scale Up ◽  
Geographic Region ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Treatment As Prevention ◽  
Hiv Incidence ◽  
Search Trial ◽  
Using Data

ABSTRACTIntroductionSEARCH is one of four randomized-controlled trials (RCTs) investigating the strategy of community-based treatment-as-prevention (TasP) for the reduction of HIV incidence in sub-Saharan Africa. SEARCH takes place among 32 pair-matched rural communities in three regions of East Africa and exceeded the UNAIDS 90-90-90 targets for HIV testing, linkage to care, and viral suppression in the intervention arm. We used mathematical modeling to estimate expected 3-year cumulative HIV incidence in both arms of the trial, using different assumptions about two main sources of uncertainty: scale-up of antiretroviral therapy (ART) in the control arm, and the degree of mixing between SEARCH residents and non-residents.MethodsWe used the HIV modelling software EMOD-HIV to configure and calibrate a new model of the SEARCH communities. The 32 trial communities were clustered into six nodes (three for the control arm and three for the intervention arm) using k-means clustering based on community HIV prevalence, male circumcision rates, mobility, and geographic region. The model was parameterized using data on demographics, HIV prevalence, male circumcision rates, and viral suppression data collected at trial baseline in 2013, and calibrated to nodespecific and age-specific HIV prevalence, ART coverage, and population size. Using data on ART scale-up in subsequent follow-up years in the trial, we varied linkage to ART in the control arm and the degree of external mixing between SEARCH residents and non-residents.ResultsIf no external mixing and no additional control arm ART linkage occurred, we estimate the trial would report a relative risk (RR) of 0.60 (95% CI 0.54-0.67, p<0.001), with all simulations showing a significant result. However, if SEARCH residents mixed equivalently with non-residents and ART linkage in the control arm also increased such that the control arm also exceeded the 73% viral suppression target, the RR is estimated to be 0.96 (95% CI 0.87-1.06, p=0.458) and 72% of simulations are non-significant. Given our “best guess” assumptions about external mixing and year 3 data on ART linkage in the control arm, the RR is estimated to be 0.90 (95% CI 0.81-1.00, p=0.05), with 49% non-significant simulations.ConclusionThe SEARCH trial is predicted to show a 4-40% reduction in cumulative 3-year incidence, but between 18-72% of simulations were non-significant if either or both ART linkage in the control arm and external mixing are substantial. Despite achieving the 90-90-90 targets, our “best guess” is that the SEARCH trial has an equal probability of reporting a non-significant reduction in HIV incidence as it does a significant reduction.

scholarly journals Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda

JAMA ◽  
2016 ◽  
Vol 316 (2) ◽  
pp. 182 ◽  
Author(s):  
Xiangrong Kong ◽  
Godfrey Kigozi ◽  
Joseph Ssekasanvu ◽  
Fred Nalugoda ◽  
Gertrude Nakigozi ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Male Circumcision ◽  
Scale Up ◽  
Hiv Incidence ◽  
Medical Male Circumcision

scholarly journals Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up

2018 ◽  
Vol 29 (14) ◽  
pp. 1432-1443 ◽  
Author(s):  
Jason B Reed ◽  
Rupa R Patel ◽  
Rachel Baggaley
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Health Impact ◽  
Lessons Learned ◽  
Sub Saharan Africa ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Prep Implementation ◽  
Sub Saharan ◽  
Exposure Prophylaxis

Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact.

scholarly journals HIV epidemic trend and antiretroviral treatment need in Karonga District, Malawi

2007 ◽  
Vol 135 (6) ◽  
pp. 922-932 ◽  
Author(s):  
R. G. WHITE ◽  
E. VYNNYCKY ◽  
J. R. GLYNN ◽  
A. C. CRAMPIN ◽  
A. JAHN ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Antiretroviral Treatment ◽  
Hiv Prevalence ◽  
Hiv Incidence ◽  
Simple Mathematical Model ◽  
Population Surveys ◽  
Treatment Need ◽  
Hiv Epidemic ◽  
Using Data

SUMMARYWe describe the development of the HIV epidemic in Karonga District, Malawi over 22 years using data from population surveys and community samples. These data are used to estimate the trend in HIV prevalence, incidence and need for antiretroviral treatment (ART) using a simple mathematical model. HIV prevalence rose quickly in the late 1980s and early 1990s, stabilizing at around 12% in the mid-1990s. Estimated annual HIV incidence rose quickly, peaking in the early 1990s at 2·2% among males and 3·1% among females, and then levelled off at 1·3% among males and 1·1% among females by the late 1990s. Assuming a 2-year eligibility period, both our model and the UNAIDS models predicted 2·1% of adults were in need of ART in 2005. This prediction was sensitive to the assumed eligibility period, ranging from 1·6% to 2·6% if the eligibility period was instead assumed to be 1·5 or 2·5 years, respectively.

scholarly journals Mixed method estimation of population level HIV viral suppression rate in the Western Cape, South Africa

2020 ◽  
Author(s):  
Elton Mukonda ◽  
Nei-Yuan Hsiao ◽  
Lara Vojnov ◽  
Landon Myer ◽  
Maia Lesosky
Keyword(s):  
Viral Suppression ◽  
Routine Data ◽  
Population Level ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
People Living With Hiv ◽  
Western Cape ◽  
Test Results ◽  
Individual Level

AbstractIntroductionThere are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from ART programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates.MethodsVL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test- and individual-level VS rates were based on test VL values <1000 cps/ml, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived mid-year population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data.ResultsApproximately 1.9 million VL test results between 2008 – 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed ART coverage and population HIV prevalence.ConclusionWhile validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.

scholarly journals Model-based predictions of HIV incidence among African women using HIV risk behaviors and community-level data on male HIV prevalence and viral suppression

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
James R. Moore ◽  
Deborah J. Donnell ◽  
Marie-Claude Boily ◽  
Kate M. Mitchell ◽  
Sinead Delany-Moretlwe ◽  
...  
Keyword(s):  
Risk Behaviors ◽  
Hiv Risk ◽  
Viral Suppression ◽  
Hiv Risk Behaviors ◽  
Hiv Prevalence ◽  
Community Level ◽  
African Women ◽  
Hiv Incidence ◽  
Model Based ◽  
Level Data

scholarly journals Mixed-method estimation of population-level HIV viral suppression rate in the Western Cape, South Africa

2020 ◽  
Vol 5 (8) ◽  
pp. e002522
Author(s):  
Elton Mukonda ◽  
Nei-Yuan Hsiao ◽  
Lara Vojnov ◽  
Landon Myer ◽  
Maia Lesosky
Keyword(s):  
Viral Suppression ◽  
Routine Data ◽  
Population Level ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
People Living With Hiv ◽  
Western Cape ◽  
Test Results ◽  
Individual Level

IntroductionThere are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from antiretroviral therapy (ART) programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates.MethodsVL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test-level and individual-level VS rates were based on test VL values <1000 cps/mL, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived midyear population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data.ResultsApproximately 1.9 million VL test results between 2008 and 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed VL testing coverage and population HIV prevalence.ConclusionWhile validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.

scholarly journals HIV prevalence and sexual behaviour at older ages in rural Malawi

2012 ◽  
Vol 23 (7) ◽  
pp. 490-496 ◽  
Author(s):  
E Freeman ◽  
P Anglewicz
Keyword(s):  
Hiv Infection ◽  
Hiv Risk ◽  
Sexual Behaviour ◽  
Hiv Prevalence ◽  
Sub Saharan Africa ◽  
Older Individuals ◽  
Number Of Sexual Partners ◽  
Sub Saharan ◽  
Using Data ◽  
Older Populations

Research on HIV infection and sexual behaviour in sub-Saharan Africa typically focuses on individuals aged 15–49 years under the assumption that both become less relevant for older individuals. We test this assumption using data from rural Malawi to compare sexual behaviour and HIV infection for individuals aged 15–49 with individuals aged 50–64 and 65 and over years. Although general declines with age were observed, levels of sexual activity and HIV remained considerable: 26.7% and 73.8% of women and men aged 65+ reported having sex in the last year, respectively; men's average number of sexual partners remained above one; and HIV prevalence is significantly higher for men aged 50–64 (8.9%) than men aged 15–49 (4.1 %). We conclude that older populations are relevant to studies of sexual behaviour and HIV risk. Their importance is likely to increase as access to antiretrovirals in Africa increases. We recommend inclusion of adults aged over 49 years in African HIV/AIDS research and prevention efforts.

Sign in / Sign up

Export Citation Format

Share Document