HIV

  • Perspectives on the use of modelling and economic analysis to guide HIV programmes in sub-Saharan Africa

    HIV modelling and economic analyses have had a prominent role in guiding programmatic responses to HIV in sub-Saharan Africa. However, there has been little reflection on how the HIV modelling field might develop in future. HIV modelling should more routinely align with national government and ministry of health priorities, recognising their legitimate mandates and stewardship…

  • Large age-shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa

    Recent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist…

  • The influence of mobility among high-risk populations on HIV transmission in Western Kenya

    Western Kenya suffers a highly endemic and also very heterogeneous epidemic of human immunodeficiency virus (HIV). Although female sex workers (FSW) and their male clients are known to be at high risk for HIV, HIV prevalence across regions in Western Kenya is not strongly correlated with the fraction of women engaged in commercial sex. An…

  • The missing 27%

    Though a wide body of observational and model-based evidence underscores the promise of Universal Test and Treat (UTT) to reduce population-level HIV incidence in high-burden areas of Sub-Saharan Africa (SSA), the only cluster- randomized trial of UTT completed to date, ANRS 12249, did not show a significant reduction in incidence. More UTT trials are currently…

  • Relationship formation and flow control algorithms for generating age-structured networks in HIV modeling

    Age mixing plays an important role in the formation of relationships within computer simulations of Human Immunodeficiency Virus (HIV) transmission. We present and analyze an algorithm that takes individuals seeking a heterosexual relationship, and forms pairs of a desired joint age mixing distribution. The rate at which eligible individuals seek relationships varies by age group…

  • Sexual partnership age pairings and risk of HIV acquisition in rural South Africa

    Objective To quantify the contribution of specific sexual partner age groups to the risk of HIV acquisition in men and women in hyperendemic region of South Africa. Design We conducted a population-based cohort study among women (15–49 years of age) and men (15–55 years of age) between 2004 and 2015 in KwaZulu-Natal, South Africa. Methods:…

  • Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics

    Background Migrant populations such as mine workers contributed to the spread of HIV in sub-Saharan Africa. We used a mathematical model to estimate the community-wide impact of targeting treatment and prevention to male migrants. Methods We augmented an individual-based network model, EMOD-HIV v0.8, to include an age-dependent propensity for males to migrate. Migrants were exposed…

  • The Cost and Cost-Effectiveness of Alternative Strategies to Expand Treatment to HIV-Positive South Africans

    To study the effects of malaria-control interventions on parasite population genomics, we examined a set of 1,007 samples of the malaria parasite Plasmodium falciparum collected in Thiès, Senegal between 2006 and 2013. The parasite samples were genotyped using a molecular barcode of 24 SNPs. About 35% of the samples grouped into subsets with identical barcodes,…

  • The effect of 90-90-90 on HIV-1 incidence and mortality in eSwatini: a mathematical modelling study

    Background The rapid scale-up of antiretroviral therapy (ART) towards the UNAIDS 90-90-90 goals over the last decade has sparked considerable debate as to whether universal test and treat can end the HIV-1 epidemic in sub-Saharan Africa. We aimed to develop a network transmission model, calibrated to capture age-specific and sex-specific gaps in the scale-up of…

  • People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda

    Introduction The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face…