Estill, Janne; Kerr, Cliff C; Blaser, Nello; Salazar-Vizcaya, Luisa; Tenthani, Lyson; Wilson, David P; Keiser, Olivia (2018). The Effect of Monitoring Viral Load and Tracing Patients Lost to Follow-up on the Course of the HIV Epidemic in Malawi: A Mathematical Model. Open Forum Infectious Diseases, 5(5), ofy092. Oxford University Press 10.1093/ofid/ofy092
|
Text
Estill OpenForumInfectDis 2018.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (318kB) | Preview |
Background
Antiretroviral therapy (ART) reduces HIV transmission, but treated patients may again become infectious. We used a mathematical model to determine whether ART as prevention is more effective if viral load (VL) is routinely monitored and patients lost to follow-up (LTFU) traced.
Methods
We simulated ART cohorts to parameterize a deterministic transmission model calibrated to Malawi. We investigated the following strategies for improving treatment and retention: monitoring VL every 12 or 24 months, tracing patients LTFU, or a generic strategy leading to uninterrupted treatment. We tested 3 scenarios, where ART scale-up continues at current (Universal ART), reduced (Failed scale-up), or accelerated speed (Test&Treat).
Results
In the Universal ART scenario, between 2017 and 2020 (2050), monitoring VL every 24 months prevented 0.5% (0.9%), monitoring every 12 months prevented 0.8% (1.4%), tracing prevented 0.3% (0.5%), and uninterrupted treatment prevented 5.5% (9.9%) of HIV infections. Failed scale-up resulted in 25% more infections than the Universal ART scenarios, whereas Test&Treat resulted in 7%-8% less.
Conclusions
Test&Treat reduces transmission of HIV, despite individual cases of treatment failure and ART interruption. Whereas viral load monitoring and tracing have only a minor impact on transmission, interventions that aim to minimize treatment interruptions can further increase the preventive effect of ART.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
08 Faculty of Science > Department of Mathematics and Statistics > Institute of Mathematical Statistics and Actuarial Science 04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) |
UniBE Contributor: |
Estill, Janne Anton Markus, Blaser, Nello, Salazar Vizcaya, Luisa Paola, Tenthani, Lyson Nemoni, Keiser, Olivia |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services 500 Science > 510 Mathematics |
ISSN: |
2328-8957 |
Publisher: |
Oxford University Press |
Language: |
English |
Submitter: |
Tanya Karrer |
Date Deposited: |
28 Aug 2018 12:02 |
Last Modified: |
05 Dec 2022 15:16 |
Publisher DOI: |
10.1093/ofid/ofy092 |
PubMed ID: |
29977952 |
Uncontrolled Keywords: |
HIV; antiretroviral therapy; loss to follow-up; mathematical model; monitoring; transmission |
BORIS DOI: |
10.7892/boris.118550 |
URI: |
https://boris.unibe.ch/id/eprint/118550 |
Actions (login required)
 |
Edit item |