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Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis

INTRODUCTION: Prevention of mother-to-child HIV transmission (PMTCT) strategies include combined short-course antiretrovirals during pregnancy (Option A), triple-drug antiretroviral treament (ART) during pregnancy and breastfeeding (Option B), or lifelong ART (Option B+). The WHO also recommends ART...

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Autores principales: Khanna, Aditya S., Roberts, Sarah T., Cassels, Susan, Ying, Roger, John-Stewart, Grace, Goodreau, Steven M., Baeten, Jared M., Murnane, Pamela M., Celum, Connie, Barnabas, Ruanne V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532442/
https://www.ncbi.nlm.nih.gov/pubmed/26262889
http://dx.doi.org/10.1371/journal.pone.0134271
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author Khanna, Aditya S.
Roberts, Sarah T.
Cassels, Susan
Ying, Roger
John-Stewart, Grace
Goodreau, Steven M.
Baeten, Jared M.
Murnane, Pamela M.
Celum, Connie
Barnabas, Ruanne V.
author_facet Khanna, Aditya S.
Roberts, Sarah T.
Cassels, Susan
Ying, Roger
John-Stewart, Grace
Goodreau, Steven M.
Baeten, Jared M.
Murnane, Pamela M.
Celum, Connie
Barnabas, Ruanne V.
author_sort Khanna, Aditya S.
collection PubMed
description INTRODUCTION: Prevention of mother-to-child HIV transmission (PMTCT) strategies include combined short-course antiretrovirals during pregnancy (Option A), triple-drug antiretroviral treament (ART) during pregnancy and breastfeeding (Option B), or lifelong ART (Option B+). The WHO also recommends ART for HIV treatment and prevention of sexual transmission of HIV. The impact of PMTCT strategies on prevention of sexual HIV transmission of HIV is not known. We estimated the population-level impact of PMTCT interventions on heterosexual HIV transmission in southwestern Uganda and KwaZulu-Natal, South Africa, two regions with different HIV prevalence and fertility rates. MATERIALS AND METHODS: We constructed and validated dynamic, stochastic, network-based HIV transmission models for each region. PMTCT Options A, B, and B+ were simulated over ten years under three scenarios: 1) current ART and PMTCT coverage, 2) current ART and high PMTCT coverage, and 3) high ART and PMTCT coverage. We compared adult HIV incidence after ten years of each intervention to Option A (and current ART) at current coverage. RESULTS: At current coverage, Options B and B+ reduced heterosexual HIV incidence by about 5% and 15%, respectively, in both countries. With current ART and high PMTCT coverage, Option B+ reduced HIV incidence by 35% in Uganda and 19% in South Africa, while Option B had smaller, but meaningful, reductions. The greatest reductions in HIV incidence were achieved with high ART and PMTCT coverage. In this scenario, all PMTCT strategies yielded similar results. DISCUSSION: Implementation of Options B/B+ reduces adult HIV incidence, with greater effect (relative to Option A at current levels) in Uganda than South Africa. These results are likely driven by Uganda’s higher fertility rates.
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spelling pubmed-45324422015-08-20 Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis Khanna, Aditya S. Roberts, Sarah T. Cassels, Susan Ying, Roger John-Stewart, Grace Goodreau, Steven M. Baeten, Jared M. Murnane, Pamela M. Celum, Connie Barnabas, Ruanne V. PLoS One Research Article INTRODUCTION: Prevention of mother-to-child HIV transmission (PMTCT) strategies include combined short-course antiretrovirals during pregnancy (Option A), triple-drug antiretroviral treament (ART) during pregnancy and breastfeeding (Option B), or lifelong ART (Option B+). The WHO also recommends ART for HIV treatment and prevention of sexual transmission of HIV. The impact of PMTCT strategies on prevention of sexual HIV transmission of HIV is not known. We estimated the population-level impact of PMTCT interventions on heterosexual HIV transmission in southwestern Uganda and KwaZulu-Natal, South Africa, two regions with different HIV prevalence and fertility rates. MATERIALS AND METHODS: We constructed and validated dynamic, stochastic, network-based HIV transmission models for each region. PMTCT Options A, B, and B+ were simulated over ten years under three scenarios: 1) current ART and PMTCT coverage, 2) current ART and high PMTCT coverage, and 3) high ART and PMTCT coverage. We compared adult HIV incidence after ten years of each intervention to Option A (and current ART) at current coverage. RESULTS: At current coverage, Options B and B+ reduced heterosexual HIV incidence by about 5% and 15%, respectively, in both countries. With current ART and high PMTCT coverage, Option B+ reduced HIV incidence by 35% in Uganda and 19% in South Africa, while Option B had smaller, but meaningful, reductions. The greatest reductions in HIV incidence were achieved with high ART and PMTCT coverage. In this scenario, all PMTCT strategies yielded similar results. DISCUSSION: Implementation of Options B/B+ reduces adult HIV incidence, with greater effect (relative to Option A at current levels) in Uganda than South Africa. These results are likely driven by Uganda’s higher fertility rates. Public Library of Science 2015-08-11 /pmc/articles/PMC4532442/ /pubmed/26262889 http://dx.doi.org/10.1371/journal.pone.0134271 Text en © 2015 Khanna et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Khanna, Aditya S.
Roberts, Sarah T.
Cassels, Susan
Ying, Roger
John-Stewart, Grace
Goodreau, Steven M.
Baeten, Jared M.
Murnane, Pamela M.
Celum, Connie
Barnabas, Ruanne V.
Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
title Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
title_full Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
title_fullStr Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
title_full_unstemmed Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
title_short Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
title_sort estimating pmtct's impact on heterosexual hiv transmission: a mathematical modeling analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532442/
https://www.ncbi.nlm.nih.gov/pubmed/26262889
http://dx.doi.org/10.1371/journal.pone.0134271
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