Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.

<h4>Background</h4>The core-group theory of sexually transmitted infections suggests that targeting prevention to high-risk groups (HRG) could be very effective. We aimed to quantify the contribution of heterosexual HRGs and the potential impact of focused interventions to HIV transmissi...

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Autores principales:	Sharmistha Mishra, Richard Steen, Antonio Gerbase, Ying-Ru Lo, Marie-Claude Boily
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bb1ee249cffa47779d6c360a6b16820f
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spelling	oai:doaj.org-article:bb1ee249cffa47779d6c360a6b16820f2021-11-18T08:06:45ZImpact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.1932-620310.1371/journal.pone.0050691https://doaj.org/article/bb1ee249cffa47779d6c360a6b16820f2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23226357/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The core-group theory of sexually transmitted infections suggests that targeting prevention to high-risk groups (HRG) could be very effective. We aimed to quantify the contribution of heterosexual HRGs and the potential impact of focused interventions to HIV transmission in the wider community.<h4>Methods</h4>We systematically identified studies published between 1980 and 2011. Studies were included if they used dynamical models of heterosexual HIV transmission, incorporated behavioural heterogeneity in risk, and provided at least one of the following primary estimates in the wider community (a) the population attributable fraction (PAF) of HIV infections due to HRGs, or (b) the number per capita or fraction of HIV infections averted, or change in HIV prevalence/incidence due to focused interventions.<h4>Findings</h4>Of 267 selected articles, 22 were included. Four studies measured the PAF, and 20 studies measured intervention impact across 265 scenarios. In low-prevalence epidemics (≤5% HIV prevalence), the estimated impact of sex-worker interventions in the absence of risk compensation included: 6-100% infections averted; 0.9-6.2 HIV infections averted per 100,000 adults; 11-94% and 4-47% relative reduction in prevalence and incidence respectively. In high-prevalence epidemics (>5% HIV prevalence), sex-worker interventions were estimated to avert 6.8-40% of HIV infections and up to 564 HIV infections per 100,000 adults, and reduce HIV prevalence and incidence by 13-27% and 2-14% respectively. In both types of epidemics, greater heterogeneity in HIV risk was associated with a larger impact on the fraction of HIV infections averted and relative reduction in HIV incidence.<h4>Conclusion</h4>Focused interventions, as estimated by mathematical models, have the potential to reduce HIV transmission in the wider community across low- and high-prevalence regions. However, considerable variability exists in estimated impact, suggesting that a targeted approach to HIV prevention should be tailored to local epidemiological context.Sharmistha MishraRichard SteenAntonio GerbaseYing-Ru LoMarie-Claude BoilyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 11, p e50691 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sharmistha Mishra Richard Steen Antonio Gerbase Ying-Ru Lo Marie-Claude Boily Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.
description	<h4>Background</h4>The core-group theory of sexually transmitted infections suggests that targeting prevention to high-risk groups (HRG) could be very effective. We aimed to quantify the contribution of heterosexual HRGs and the potential impact of focused interventions to HIV transmission in the wider community.<h4>Methods</h4>We systematically identified studies published between 1980 and 2011. Studies were included if they used dynamical models of heterosexual HIV transmission, incorporated behavioural heterogeneity in risk, and provided at least one of the following primary estimates in the wider community (a) the population attributable fraction (PAF) of HIV infections due to HRGs, or (b) the number per capita or fraction of HIV infections averted, or change in HIV prevalence/incidence due to focused interventions.<h4>Findings</h4>Of 267 selected articles, 22 were included. Four studies measured the PAF, and 20 studies measured intervention impact across 265 scenarios. In low-prevalence epidemics (≤5% HIV prevalence), the estimated impact of sex-worker interventions in the absence of risk compensation included: 6-100% infections averted; 0.9-6.2 HIV infections averted per 100,000 adults; 11-94% and 4-47% relative reduction in prevalence and incidence respectively. In high-prevalence epidemics (>5% HIV prevalence), sex-worker interventions were estimated to avert 6.8-40% of HIV infections and up to 564 HIV infections per 100,000 adults, and reduce HIV prevalence and incidence by 13-27% and 2-14% respectively. In both types of epidemics, greater heterogeneity in HIV risk was associated with a larger impact on the fraction of HIV infections averted and relative reduction in HIV incidence.<h4>Conclusion</h4>Focused interventions, as estimated by mathematical models, have the potential to reduce HIV transmission in the wider community across low- and high-prevalence regions. However, considerable variability exists in estimated impact, suggesting that a targeted approach to HIV prevention should be tailored to local epidemiological context.
format	article
author	Sharmistha Mishra Richard Steen Antonio Gerbase Ying-Ru Lo Marie-Claude Boily
author_facet	Sharmistha Mishra Richard Steen Antonio Gerbase Ying-Ru Lo Marie-Claude Boily
author_sort	Sharmistha Mishra
title	Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.
title_short	Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.
title_full	Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.
title_fullStr	Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.
title_full_unstemmed	Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.
title_sort	impact of high-risk sex and focused interventions in heterosexual hiv epidemics: a systematic review of mathematical models.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/bb1ee249cffa47779d6c360a6b16820f
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Impact of high-risk sex and focused interventions in heterosexual HIV epidemics: a systematic review of mathematical models.

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