Loss to follow-up (LTFU) is a serious problem in most sub-Saharan African ART programmes. If ART is interrupted or reduced, HIV again progresses, and this increases the risk of opportunistic infections and, ultimately, AIDS and death. In addition, the viral load of a patient who interrupts ART will rebound, and the probability of onward transmission increases. If tracing programmes can accelerate the return of lost patients, these patients may be less likely to transmit the virus, since the period of lapsed treatment is shortened. In this study, we created a mathematical model to determine whether tracing patients LTFU from ART programs would lower the rate of HIV transmission.
Young women in relationships with older men are typically at an elevated risk for acquisition of HIV in sub-Saharan Africa. Most qualitative studies have tended to focus on why women are motivated to participate in these relationships, offering little insight into perceived risks of these relationships. Therefore we conducted a qualitative study in three urban communities in Cape Town using thematic content analysis to explore women’s perceived risks of (non-)age-disparate relationships, the benefits of dating older men, and risk perceptions that influence decisions around these relationships.
My motivation to plan for the mathematical modelling of the HIV epidemic in Viet Nam has been to demonstrate the benefits of earlier initiation of antiretroviral treatment (ART). I especially wanted to estimate the potential impact of ART to prevent HIV transmission in communities. I hoped that the results would potentially influence the society to become more serious in creating an environment in which people feel safe to access HIV testing and counselling and treatment early, especially for the people who inject drugs and other groups who have a high HIV incidence. Here I tell you my journey to realize my plan.
On June 19, 2012, SACEMA’s Brian Williams, also Senior Technical Adviser to Test & Treat to End AIDS, held a briefing in Washington DC in which he explained to US senators, members of congress, and staff how this strategy has the potential to stop the spread of HIV/AIDS and, over time, to save billions of Read More
A recent randomized controlled trial demonstrated that antiretroviral therapy (ART) prevents HIV transmission. In successfully treated patients the HI virus in the blood is suppressed to undetectable levels and therefore the probability of transmitting the virus is extremely low. This new finding must be incorporated into the evaluation of the advantages and disadvantages of different ART provision strategies. The optimal strategy for monitoring treatment response and detecting treatment failure – routine viral load monitoring (rVL) or CD4 cell counts or clinical symptoms – has been the subject of continuous debate. We suspected that rVL could potentially prevent HIV transmission by making it easier to detect treatment failure earlier. We developed a mathematical simulation model to estimate potential transmission from 1,000 patients treated with ART with either rVL or CD4 monitoring.
The role of treatment as prevention / the test and treat strategy to reduce the HIV incidence continues to be a hot topic
We need to move from theory to practice and fund, implement and evaluate the test-and-treat strategy.
Many mathematical models have investigated the impact of HIV treatment as prevention in combination with other prevention strategies or other guidelines for HIV treatment provision. Generally, all models have predicted positive prevention benefits of HIV treatment, but directly comparing the results of different models has been challenging because each model has been used to answer different questions and has reported different key outcomes. In November 2011, the HIV Modelling Consortium convened a meeting with the aim to understand the extent to which different mathematical models agree about the potential impact of HIV treatment. The results of a model comparison exercise – in which each of the models simulated a standardised set of HIV intervention scenarios and reported common metrics of intervention impact – are reported here.
Household surveys estimate the proportion of HIV infected persons in KwaZulu-Natal at a level of ~23% of the population. What is urgently needed is to seek ways to reduce HIV incidence while caring for existing infections in KZN. The emerging course of action against HIV spread is to use a combination of prevention interventions rather than relying on individual tools. This article discusses mathematical modelling conducted to forecast the impact of combined interventions at both the short- and long-term. The modelling shows the importance of repeated high coverage of testing, linkage to care, starting treatment on time (at CD4 count 350 or less), and high coverage of circumcision in order to reduce the rate of HIV infection in KZN.
In December 2011 Jon Cohen published an article in which he discussed the prospects for halting the epidemic of HIV/AIDS (1). He highlights the important observation that, due to recent evidence on effective interventions to prevent HIV, we have for the first time the means by which to end the AIDS epidemic, provided of course Read More