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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda
AIDS, Volume 17, No. 13, Year 2003
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Description
Objective: To model the effects of antiretroviral therapy (ART) and HIV vaccines on HIV transmission using empirical data from studies in Rakai, Uganda. Design: A stochastic simulation model estimated HIV incidence, probabilities of transmission per coital act and the reproductive number (R0) with ART and HIV vaccines. Model inputs included Rakai data on HIV transmission probabilities per coital act by HIV viral load, age and gender, and sexual behaviors. The impacts of therapy were derived from US programs, and vaccine assumptions included preventive efficacies ranging from 25 to 75%. Component projection models estimated the numbers of HIV-infected persons over 20 years. Results: The model incidence [1.57/100 person years (PY)] closely fitted empirical data (1.5/100 PY). Simulations of ART using DHHS treatment guidelines, predicted declines in HIV incidence, but R0 remained > 1.0, and the numbers of HIV-positive persons did not change substantially over 20 years. Preventive vaccines with > 50% efficacy and > 50% population coverage could reduce R0 to < 1.0, and substantially reduce the number of HIV-infected persons over 20 years. Concurrent ART and a preventive vaccine can have substantial impact at lower levels of population coverage and would markedly reduce the HIV infected population over 20 years. However, behavioral disinhibition with increased numbers of sexual partners in either ART or vaccine recipients, increased HIV incidence and diminished intervention impact. Conclusion: ART alone cannot control the HIV epidemic in mature epidemics such as Rakai, and persons in need of therapy will increase over time. ART in combination with a low efficacy vaccine could control the epidemic, if behavioral disinhibition is prevented. © 2003 Lippincott Williams & Wilkins.
Authors & Co-Authors
Gray, Ronald H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Li, Xianbin
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Wawer, Maria J.
United States, New York
Mailman School of Public Health
Gange, Stephen J.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Serwadda, David Musoke
Uganda, Kampala
Makerere University
Sewankambo, Nelson K.
Uganda, Kampala
Makerere University
Moore, Richard D.
United States, Baltimore
The Johns Hopkins Hospital
Wabwire-Mangen, Fred
Uganda, Kampala
Makerere University
Lutalo, Tom
Uganda, Entebbe
Uganda Virus Research Institute
Quinn, Thomas Charles
United States, Baltimore
Johns Hopkins University
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
Statistics
Citations: 162
Authors: 10
Affiliations: 7
Identifiers
Doi:
10.1097/00002030-200309050-00013
Research Areas
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Study Locations
Uganda