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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
HIV treatment as prevention: Systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa
PLoS Medicine, Volume 9, No. 7, Article e1001245, Year 2012
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Description
Background: Many mathematical models have investigated the impact of expanding access to antiretroviral therapy (ART) on new HIV infections. Comparing results and conclusions across models is challenging because models have addressed slightly different questions and have reported different outcome metrics. This study compares the predictions of several mathematical models simulating the same ART intervention programmes to determine the extent to which models agree about the epidemiological impact of expanded ART. Methods and Findings: Twelve independent mathematical models evaluated a set of standardised ART intervention scenarios in South Africa and reported a common set of outputs. Intervention scenarios systematically varied the CD4 count threshold for treatment eligibility, access to treatment, and programme retention. For a scenario in which 80% of HIV-infected individuals start treatment on average 1 y after their CD4 count drops below 350 cells/μl and 85% remain on treatment after 3 y, the models projected that HIV incidence would be 35% to 54% lower 8 y after the introduction of ART, compared to a counterfactual scenario in which there is no ART. More variation existed in the estimated long-term (38 y) reductions in incidence. The impact of optimistic interventions including immediate ART initiation varied widely across models, maintaining substantial uncertainty about the theoretical prospect for elimination of HIV from the population using ART alone over the next four decades. The number of person-years of ART per infection averted over 8 y ranged between 5.8 and 18.7. Considering the actual scale-up of ART in South Africa, seven models estimated that current HIV incidence is 17% to 32% lower than it would have been in the absence of ART. Differences between model assumptions about CD4 decline and HIV transmissibility over the course of infection explained only a modest amount of the variation in model results. Conclusions: Mathematical models evaluating the impact of ART vary substantially in structure, complexity, and parameter choices, but all suggest that ART, at high levels of access and with high adherence, has the potential to substantially reduce new HIV infections. There was broad agreement regarding the short-term epidemiologic impact of ambitious treatment scale-up, but more variation in longer term projections and in the efficiency with which treatment can reduce new infections. Differences between model predictions could not be explained by differences in model structure or parameterization that were hypothesized to affect intervention impact. Please see later in the article for the Editors' Summary. © 2012 Eaton et al.
Authors & Co-Authors
Eaton, Jeffrey William
United Kingdom, London
Imperial College London
Johnson, Leigh Francis
South Africa, Cape Town
University of Cape Town
Salomon, Joshua A.
United States, Boston
Harvard T.h. Chan School of Public Health
Bärnighausen, Till Winfried
United States, Boston
Harvard T.h. Chan School of Public Health
South Africa, Durban
University of Kwazulu-natal
Bendavid, Eran
United States, Palo Alto
Stanford University
Bershteyn, Anna
United States, Bellevue
Intellectual Ventures Laboratory
Bloom, David E.
United States, Boston
Harvard T.h. Chan School of Public Health
Cambiano, Valentina
United Kingdom, London
University College London
Fraser, Christophe
United Kingdom, London
Imperial College London
Hontelez, Jan A.C.
South Africa, Durban
University of Kwazulu-natal
Netherlands, Rotterdam
Erasmus Universiteit Rotterdam
Netherlands, Nijmegen
Radboud University Medical Center
Humair, Salal
United States, Boston
Harvard T.h. Chan School of Public Health
Pakistan, Lahore
Lahore University of Management Sciences
Klein, Daniel J.
United States, Bellevue
Intellectual Ventures Laboratory
Long, Elisa F.
United States, New Haven
Yale University
Phillips, Andrew N.
United Kingdom, London
University College London
Pretorius, Carel C.
United States, Glastonbury
Avenir Health
Stover, John
United States, Glastonbury
Avenir Health
Wenger, Edward A.
United States, Bellevue
Intellectual Ventures Laboratory
Williams, Brian Gerard
South Africa, Stellenbosch
Stellenbosch University
Hallett, Timothy B.
United Kingdom, London
Imperial College London
Statistics
Citations: 382
Authors: 19
Affiliations: 13
Identifiers
Doi:
10.1371/journal.pmed.1001245
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Locations
South Africa