Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal

Christinah Mukandavire, Josephine Walker, Sheree Schwartz, Marie Claude Boily, Leon Danon, Carrie Lyons, Daouda Diouf, Ben Liestman, Nafissatou Leye Diouf, Fatou Drame, Karleen Coly, Remy Serge Manzi Muhire, Safiatou Thiam, Papa Amadou Niang Diallo, Coumba Toure Kane, Cheikh Ndour, Erik Volz, Sharmistha Mishra, Stefan Baral, Peter Vickerman

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). METHODS: A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. RESULTS: The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. CONCLUSIONS: Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.

Original languageEnglish (US)
Pages (from-to)e25126
JournalJournal of the International AIDS Society
Volume21
DOIs
StatePublished - Jul 1 2018

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Senegal
HIV
Population
Sex Workers
Unsafe Sex
Condoms
HIV Infections
Therapeutics
Population Dynamics

Keywords

  • HIV
  • clients
  • condom use
  • female sex workers
  • key populations
  • men who have sex with men
  • population attributable fraction

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal. / Mukandavire, Christinah; Walker, Josephine; Schwartz, Sheree; Boily, Marie Claude; Danon, Leon; Lyons, Carrie; Diouf, Daouda; Liestman, Ben; Diouf, Nafissatou Leye; Drame, Fatou; Coly, Karleen; Muhire, Remy Serge Manzi; Thiam, Safiatou; Diallo, Papa Amadou Niang; Kane, Coumba Toure; Ndour, Cheikh; Volz, Erik; Mishra, Sharmistha; Baral, Stefan; Vickerman, Peter.

In: Journal of the International AIDS Society, Vol. 21, 01.07.2018, p. e25126.

Research output: Contribution to journalArticle

Mukandavire, C, Walker, J, Schwartz, S, Boily, MC, Danon, L, Lyons, C, Diouf, D, Liestman, B, Diouf, NL, Drame, F, Coly, K, Muhire, RSM, Thiam, S, Diallo, PAN, Kane, CT, Ndour, C, Volz, E, Mishra, S, Baral, S & Vickerman, P 2018, 'Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal', Journal of the International AIDS Society, vol. 21, pp. e25126. https://doi.org/10.1002/jia2.25126
Mukandavire, Christinah ; Walker, Josephine ; Schwartz, Sheree ; Boily, Marie Claude ; Danon, Leon ; Lyons, Carrie ; Diouf, Daouda ; Liestman, Ben ; Diouf, Nafissatou Leye ; Drame, Fatou ; Coly, Karleen ; Muhire, Remy Serge Manzi ; Thiam, Safiatou ; Diallo, Papa Amadou Niang ; Kane, Coumba Toure ; Ndour, Cheikh ; Volz, Erik ; Mishra, Sharmistha ; Baral, Stefan ; Vickerman, Peter. / Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal. In: Journal of the International AIDS Society. 2018 ; Vol. 21. pp. e25126.
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abstract = "INTRODUCTION: Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). METHODS: A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. RESULTS: The model projections suggest that unprotected sex between men contributed to 42{\%} (2.5 to 97.5th percentile range 24 to 59{\%}) of transmissions between 1995 and 2005, increasing to 64{\%} (37 to 79{\%}) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21{\%} (7 to 39{\%}) in 1995 to 14{\%} (5 to 35{\%}) in 2015. Without ART, 49{\%} (32 to 71{\%}) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67{\%} (27 to 179{\%}) more HIV infections would have occurred, and the overall HIV prevalence would have been 60{\%} (29 to 211{\%}) greater than what it is now. Further large decreases in HIV incidence (68{\%}) can be achieved by scaling up ART in MSM to 74{\%} coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. CONCLUSIONS: Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.",
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author = "Christinah Mukandavire and Josephine Walker and Sheree Schwartz and Boily, {Marie Claude} and Leon Danon and Carrie Lyons and Daouda Diouf and Ben Liestman and Diouf, {Nafissatou Leye} and Fatou Drame and Karleen Coly and Muhire, {Remy Serge Manzi} and Safiatou Thiam and Diallo, {Papa Amadou Niang} and Kane, {Coumba Toure} and Cheikh Ndour and Erik Volz and Sharmistha Mishra and Stefan Baral and Peter Vickerman",
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T1 - Estimating the contribution of key populations towards the spread of HIV in Dakar, Senegal

AU - Mukandavire, Christinah

AU - Walker, Josephine

AU - Schwartz, Sheree

AU - Boily, Marie Claude

AU - Danon, Leon

AU - Lyons, Carrie

AU - Diouf, Daouda

AU - Liestman, Ben

AU - Diouf, Nafissatou Leye

AU - Drame, Fatou

AU - Coly, Karleen

AU - Muhire, Remy Serge Manzi

AU - Thiam, Safiatou

AU - Diallo, Papa Amadou Niang

AU - Kane, Coumba Toure

AU - Ndour, Cheikh

AU - Volz, Erik

AU - Mishra, Sharmistha

AU - Baral, Stefan

AU - Vickerman, Peter

PY - 2018/7/1

Y1 - 2018/7/1

N2 - INTRODUCTION: Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). METHODS: A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. RESULTS: The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. CONCLUSIONS: Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.

AB - INTRODUCTION: Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). METHODS: A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. RESULTS: The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. CONCLUSIONS: Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.

KW - HIV

KW - clients

KW - condom use

KW - female sex workers

KW - key populations

KW - men who have sex with men

KW - population attributable fraction

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