Can the Heterosexual HIV Epidemic be Eliminated in South Africa Using Combination Prevention? A Modeling Analysis
Authored by Nadia N Abuelezam, Alethea W McCormick, Thomas Fussell, Abena N Afriyie, Robin Wood, Victor DeGruttola, Kenneth A Freedberg, Marc Lipsitch, III George R Seage
Date Published: 2016
DOI: 10.1093/aje/kwv344
Sponsors:
United States National Institutes of Health (NIH)
Platforms:
C++
Model Documentation:
Other Narrative
Model Code URLs:
Model code not found
Abstract
Little is known about how combining efficacious interventions for human
immunodeficiency virus (HIV) prevention could lead to HIV elimination.
We used an agent-based simulation model, the HIV calibrated dynamic
model, to assess the potential for HIV elimination in South Africa. We
examined several scenarios (from continuation of the current status quo
to perfect achievement of targets) with differing combinations of male
condom use, adult male circumcision, HIV testing, and early
antiretroviral therapy (ART). We varied numerous parameters, including
the proportion of adult males circumcised, the frequency of condom use
during sex acts, acceptance of HIV testing, linkage to health care, criteria for ART initiation, ART viral suppression rates, and loss to
follow-up. Maintaining current levels of combination prevention would
lead to increasing HIV incidence and prevalence in South Africa, while
the perfect combination scenario was projected to eliminate HIV on a
50-year time scale from 2013 to 2063. Perfecting testing and treatment, without changing condom use or circumcision rates, resulted in an 89\%
reduction in HIV incidence but not elimination. Universal adult male
circumcision alone resulted in a 21\% incidence reduction within 20
years. Substantial decreases in HIV incidence are possible from
sufficient uptake of both primary prevention and ART, but with
continuation of the status quo, HIV elimination in South Africa is
unlikely within a 50-year time scale.
Tags
Infection
cost-effectiveness
Sub-saharan africa
Randomized controlled-trial
Antiretroviral therapy
Male circumcision
Causal inference
Preexposure
prophylaxis
Clinical impact
Cote-divoire