Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.

<h4>Background</h4>Expanding access to highly active antiretroviral therapy (HAART) has become an important approach to HIV prevention in recent years. Previous studies suggest that concomitant changes in risk behaviours may either help or hinder programs that use a Treatment as Preventi...

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Autores principales:	Bojan Ramadanovic, Krisztina Vasarhelyi, Ali Nadaf, Ralf W Wittenberg, Julio S G Montaner, Evan Wood, Alexander R Rutherford
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bc33b956dda54420abdb1db56d0ca1b2
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spelling	oai:doaj.org-article:bc33b956dda54420abdb1db56d0ca1b22021-11-18T07:46:49ZChanging risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.1932-620310.1371/journal.pone.0062321https://doaj.org/article/bc33b956dda54420abdb1db56d0ca1b22013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23671592/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Expanding access to highly active antiretroviral therapy (HAART) has become an important approach to HIV prevention in recent years. Previous studies suggest that concomitant changes in risk behaviours may either help or hinder programs that use a Treatment as Prevention strategy.<h4>Analysis</h4>We consider HIV-related risk behaviour as a social contagion in a deterministic compartmental model, which treats risk behaviour and HIV infection as linked processes, where acquiring risk behaviour is a prerequisite for contracting HIV. The equilibrium behaviour of the model is analysed to determine epidemic outcomes under conditions of expanding HAART coverage along with risk behaviours that change with HAART coverage. We determined the potential impact of changes in risk behaviour on the outcomes of Treatment as Prevention strategies. Model results show that HIV incidence and prevalence decline only above threshold levels of HAART coverage, which depends strongly on risk behaviour parameter values. Expanding HAART coverage with simultaneous reduction in risk behaviour act synergistically to accelerate the drop in HIV incidence and prevalence. Above the thresholds, additional HAART coverage is always sufficient to reverse the impact of HAART optimism on incidence and prevalence. Applying the model to an HIV epidemic in Vancouver, Canada, showed no evidence of HAART optimism in that setting.<h4>Conclusions</h4>Our results suggest that Treatment as Prevention has significant potential for controlling the HIV epidemic once HAART coverage reaches a threshold. Furthermore, expanding HAART coverage combined with interventions targeting risk behaviours amplify the preventive impact, potentially driving the HIV epidemic to elimination.Bojan RamadanovicKrisztina VasarhelyiAli NadafRalf W WittenbergJulio S G MontanerEvan WoodAlexander R RutherfordPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 5, p e62321 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bojan Ramadanovic Krisztina Vasarhelyi Ali Nadaf Ralf W Wittenberg Julio S G Montaner Evan Wood Alexander R Rutherford Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.
description	<h4>Background</h4>Expanding access to highly active antiretroviral therapy (HAART) has become an important approach to HIV prevention in recent years. Previous studies suggest that concomitant changes in risk behaviours may either help or hinder programs that use a Treatment as Prevention strategy.<h4>Analysis</h4>We consider HIV-related risk behaviour as a social contagion in a deterministic compartmental model, which treats risk behaviour and HIV infection as linked processes, where acquiring risk behaviour is a prerequisite for contracting HIV. The equilibrium behaviour of the model is analysed to determine epidemic outcomes under conditions of expanding HAART coverage along with risk behaviours that change with HAART coverage. We determined the potential impact of changes in risk behaviour on the outcomes of Treatment as Prevention strategies. Model results show that HIV incidence and prevalence decline only above threshold levels of HAART coverage, which depends strongly on risk behaviour parameter values. Expanding HAART coverage with simultaneous reduction in risk behaviour act synergistically to accelerate the drop in HIV incidence and prevalence. Above the thresholds, additional HAART coverage is always sufficient to reverse the impact of HAART optimism on incidence and prevalence. Applying the model to an HIV epidemic in Vancouver, Canada, showed no evidence of HAART optimism in that setting.<h4>Conclusions</h4>Our results suggest that Treatment as Prevention has significant potential for controlling the HIV epidemic once HAART coverage reaches a threshold. Furthermore, expanding HAART coverage combined with interventions targeting risk behaviours amplify the preventive impact, potentially driving the HIV epidemic to elimination.
format	article
author	Bojan Ramadanovic Krisztina Vasarhelyi Ali Nadaf Ralf W Wittenberg Julio S G Montaner Evan Wood Alexander R Rutherford
author_facet	Bojan Ramadanovic Krisztina Vasarhelyi Ali Nadaf Ralf W Wittenberg Julio S G Montaner Evan Wood Alexander R Rutherford
author_sort	Bojan Ramadanovic
title	Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.
title_short	Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.
title_full	Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.
title_fullStr	Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.
title_full_unstemmed	Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.
title_sort	changing risk behaviours and the hiv epidemic: a mathematical analysis in the context of treatment as prevention.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/bc33b956dda54420abdb1db56d0ca1b2
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Changing risk behaviours and the HIV epidemic: a mathematical analysis in the context of treatment as prevention.

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