Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015)

Mathieu Maheu-Giroux, Juan F. Vesga, Souleymane Diabaté, Michel Alary, Stefan Baral, Daouda Diouf, Kouamé Abo, Marie Claude Boily

Research output: Contribution to journalArticle

Abstract

Introduction: Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods: An age-stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results: Overall, condom use averted 61% (95% credible intervals: 56%-66%) of all adult infections during 1987-2015 mainly because of increased use by FSW (46% of infections averted). In comparison, ART prevented 15% (10%-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91%-97%) of all new infections, declining to 19% (11%-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributors to transmission. Men who have sex with men contributed ≤4% transmissions throughout. Young women (15-24 years; excluding FSW) do not transmit more infections than they acquired. Conclusions: Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSWs and older men have become the main source of transmission, whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and clients of female sex workers, is important.

Original languageEnglish (US)
Pages (from-to)517-527
Number of pages11
JournalJournal of Acquired Immune Deficiency Syndromes
Volume75
Issue number5
DOIs
StatePublished - Aug 15 2017

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Sex Workers
HIV
Infection
Condoms
Population
HIV Infections
Therapeutics
Mothers

Keywords

  • compartmental model
  • impact evaluation
  • Ivory Coast
  • key populations
  • transmission dynamics
  • West Africa

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Changing Dynamics of HIV Transmission in Côte d'Ivoire : Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015). / Maheu-Giroux, Mathieu; Vesga, Juan F.; Diabaté, Souleymane; Alary, Michel; Baral, Stefan; Diouf, Daouda; Abo, Kouamé; Boily, Marie Claude.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 75, No. 5, 15.08.2017, p. 517-527.

Research output: Contribution to journalArticle

Maheu-Giroux, Mathieu ; Vesga, Juan F. ; Diabaté, Souleymane ; Alary, Michel ; Baral, Stefan ; Diouf, Daouda ; Abo, Kouamé ; Boily, Marie Claude. / Changing Dynamics of HIV Transmission in Côte d'Ivoire : Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015). In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 75, No. 5. pp. 517-527.
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abstract = "Introduction: Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods: An age-stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results: Overall, condom use averted 61{\%} (95{\%} credible intervals: 56{\%}-66{\%}) of all adult infections during 1987-2015 mainly because of increased use by FSW (46{\%} of infections averted). In comparison, ART prevented 15{\%} (10{\%}-19{\%}) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95{\%} (91{\%}-97{\%}) of all new infections, declining to 19{\%} (11{\%}-27{\%}) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributors to transmission. Men who have sex with men contributed ≤4{\%} transmissions throughout. Young women (15-24 years; excluding FSW) do not transmit more infections than they acquired. Conclusions: Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSWs and older men have become the main source of transmission, whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and clients of female sex workers, is important.",
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T1 - Changing Dynamics of HIV Transmission in Côte d'Ivoire

T2 - Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976-2015)

AU - Maheu-Giroux, Mathieu

AU - Vesga, Juan F.

AU - Diabaté, Souleymane

AU - Alary, Michel

AU - Baral, Stefan

AU - Diouf, Daouda

AU - Abo, Kouamé

AU - Boily, Marie Claude

PY - 2017/8/15

Y1 - 2017/8/15

N2 - Introduction: Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods: An age-stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results: Overall, condom use averted 61% (95% credible intervals: 56%-66%) of all adult infections during 1987-2015 mainly because of increased use by FSW (46% of infections averted). In comparison, ART prevented 15% (10%-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91%-97%) of all new infections, declining to 19% (11%-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributors to transmission. Men who have sex with men contributed ≤4% transmissions throughout. Young women (15-24 years; excluding FSW) do not transmit more infections than they acquired. Conclusions: Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSWs and older men have become the main source of transmission, whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and clients of female sex workers, is important.

AB - Introduction: Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods: An age-stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results: Overall, condom use averted 61% (95% credible intervals: 56%-66%) of all adult infections during 1987-2015 mainly because of increased use by FSW (46% of infections averted). In comparison, ART prevented 15% (10%-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91%-97%) of all new infections, declining to 19% (11%-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributors to transmission. Men who have sex with men contributed ≤4% transmissions throughout. Young women (15-24 years; excluding FSW) do not transmit more infections than they acquired. Conclusions: Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSWs and older men have become the main source of transmission, whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and clients of female sex workers, is important.

KW - compartmental model

KW - impact evaluation

KW - Ivory Coast

KW - key populations

KW - transmission dynamics

KW - West Africa

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