Exploring the population-level impact of antiretroviral treatment: the influence of baseline intervention context.


Mishra, S; Mountain, E; Pickles, M; Vickerman, P; Shastri, S; Gilks, C; Dhingra, NK; Washington, R; Becker, ML; Blanchard, JF; Alary, M; Boily, MC; Strategic Epi-ART in India Modelling Team, ; (2014) Exploring the population-level impact of antiretroviral treatment: the influence of baseline intervention context. AIDS (London, England), 28 Suppl 1. S61-72. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0000000000000109

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Abstract

OBJECTIVE To compare the potential population-level impact of expanding antiretroviral treatment (ART) in HIV epidemics concentrated among female sex workers (FSWs) and clients, with and without existing condom-based FSW interventions. DESIGN Mathematical model of heterosexual HIV transmission in south India. METHODS We simulated HIV epidemics in three districts to assess the 10-year impact of existing ART programs (ART eligibility at CD4 cell count ≤350) beyond that achieved with high condom use, and the incremental benefit of expanding ART by either increasing ART eligibility, improving access to care, or prioritizing ART expansion to FSWs/clients. Impact was estimated in the total population (including FSWs and clients). RESULTS In the presence of existing condom-based interventions, existing ART programs (medium-to-good coverage) were predicted to avert 11-28% of remaining HIV infections between 2014 and 2024. Increasing eligibility to all risk groups prevented an incremental 1-15% over existing ART programs, compared with 29-53% when maximizing access to all risk groups. If there was no condom-based intervention, and only poor ART coverage, then expanding ART prevented a larger absolute number but a smaller relative fraction of HIV infections for every additional person-year of ART. Across districts and baseline interventions, for every additional person-year of treatment, prioritizing access to FSWs was most efficient (and resource saving), followed by prioritizing access to FSWs and clients. CONCLUSION The relative and absolute benefit of ART expansion depends on baseline condom use, ART coverage, and epidemic size. In south India, maximizing FSWs' access to care, followed by maximizing clients' access are the most efficient ways to expand ART for HIV prevention, across baseline intervention context.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 24468948
Web of Science ID: 334160100007
URI: http://researchonline.lshtm.ac.uk/id/eprint/1496200

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