Displacement of sexual partnerships in trials of sexual behavior interventions: A model -based assessment of consequences
Authored by Nadia N Abuelezam, Alethea W McCormick, Thomas Fussell, Marc Lipsitch, III George R Seage
Date Published: 2017
DOI: 10.1016/j.epidem.2017.03.007
Sponsors:
United States National Institutes of Health (NIH)
Platforms:
No platforms listed
Model Documentation:
Other Narrative
Model Code URLs:
Model code not found
Abstract
We investigated the impact of the displacement of sexual activity from
adherent recipients of an intervention to others within or outside a
trial population on the results from hypothetical trials of different
sexual behavior interventions. A short-term model of HIV-prevention
interventions that lead to female rejection of male partnership requests
showed the impact of displacement expected at the start of a trial. An
agent-based model, with sexual mixing and other South African specific
demographics, evaluated consequences of displacement for sexual behavior
interventions targeting young females in South Africa. This model
measured the cumulative incidence among adherent, non-adherent, control
and non enrolled females in a hypothetical trial of HIV prevention. When
males made more than one attempt to seek a partnership, interventions
reduced short-term HIV infection risk among adherent females, but
increased it among non-adherent females as well as controls,
non-enrolled (females eligible for the trial but not chosen to
participate) and ineligible females (females that did not qualify for
the trial due to age). The impact of displacement depends on the
intervention and the adherence. In both models, the risk to individuals
who are not members of the adherent intervention group will increase
with displacement leading to a biased calculation for the effect
estimates for the trial. Likewise, intent-to-treat effect estimates
become nonlinear functions of the proportion adherent. (C) 2017 The
Authors. Published by Elsevier B.V.
Tags
Agent-based modeling
Displacement
HIV prevention
cost-effectiveness
Africa
Prevalence
disease
Resistance
Young-women
Trial design
Conditional cash transfer
Preventive therapy
Transfer program
Hiv-prevention