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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: A modelling study
The Lancet, Volume 378, No. 9787, Year 2011
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Description
HIV transmission risk is higher during acute and early HIV infection than it is during chronic infection, but the contribution of early infection to the spread of HIV is controversial. We estimated the contribution of early infection to HIV incidence in Lilongwe, Malawi, and predict the future effect of hypothetical prevention interventions targeted at early infection only, chronic infection only, or both stages. We developed a deterministic mathematical model describing heterosexual HIV transmission, informed by detailed behavioural and viral-load data collected in Lilongwe. We included sexual contact within and outside of steady pairs and divided the infectious period into intervals to allow for changes in transmissibility by infection stage. We used a Bayesian melding approach to fit the model to HIV prevalence data collected between 1987 and 2005 at Lilongwe antenatal clinics. We assessed interventions that reduced the per-contact transmission probability to 0·00003 in people receiving them, and varied the proportion of individuals receiving the intervention in each stage. We estimated that 38·4 (95 credible interval 18·6-52·3) of HIV transmissions in Lilongwe are attributable to sexual contact with individuals with early infection. Interventions targeted at only early infection substantially reduced HIV prevalence, but did not lead to elimination, even with 100 coverage. Interventions targeted at only chronic infections also reduced HIV prevalence, but coverage levels of 95-99 were needed for the elimination of HIV. In scenarios with less than 95 coverage of interventions targeted at chronic infections, additional interventions reaching 25-75 of individuals with early infection reduced HIV prevalence substantially. Our results suggest that early infection plays an important part in HIV transmission in this sub-Saharan African setting. Without near-complete coverage, interventions during chronic infection will probably have incomplete effectiveness unless complemented by strategies targeting individuals with early HIV infection. National Institutes of Health, University of North Carolina Center for AIDS Research. © 2011 Elsevier Ltd.
Authors & Co-Authors
Powers, Kimberly A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
United States, Atlanta
National Center for Infectious Diseases
Ghani, Azra C.H.
United Kingdom, London
Imperial College London
Miller, William C.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Hoffman, Irving F.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Pettifor, Audrey E.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Kamanga, Gift
Malawi, Lilongwe
Unc Project-malawi
Martinson, Francis E.A.
Malawi, Lilongwe
Unc Project-malawi
Cohen, Myron S.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 320
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1016/S0140-6736(11)60842-8
ISSN:
01406736
e-ISSN:
1474547X
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Locations
Malawi