Combination HIV prevention among MSM in South Africa: results from agent-based modeling

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dc.contributor.authorBrookmeyer, Ronen_ZA
dc.contributor.authorBoren, Daviden_ZA
dc.contributor.authorBaral, Stefan Den_ZA
dc.contributor.authorBekker, Linda- Gailen_ZA
dc.contributor.authorPhaswana-Mafuya, Nancyen_ZA
dc.contributor.authorBeyrer, Chrisen_ZA
dc.contributor.authorSullivan, Patrick Sen_ZA
dc.date.accessioned2015-11-23T12:28:31Z
dc.date.available2015-11-23T12:28:31Z
dc.date.issued2014en_ZA
dc.description.abstractHIV prevention trials have demonstrated the effectiveness of a number of behavioral and biomedical interventions. HIV prevention packages are combinations of interventions and offer potential to significantly increase the effectiveness of any single intervention. Estimates of the effectiveness of prevention packages are important for guiding the development of prevention strategies and for characterizing effect sizes before embarking on large scale trials. Unfortunately, most research to date has focused on testing single interventions rather than HIV prevention packages. Here we report the results from agent-based modeling of the effectiveness of HIV prevention packages for men who have sex with men (MSM) in South Africa. We consider packages consisting of four components: antiretroviral therapy for HIV infected persons with CD4 count <350; PrEP for high risk uninfected persons; behavioral interventions to reduce rates of unprotected anal intercourse (UAI); and campaigns to increase HIV testing. We considered 163 HIV prevention packages corresponding to different intensity levels of the four components. We performed 2252 simulation runs of our agent-based model to evaluate those packages. We found that a four component package consisting of a 15% reduction in the rate of UAI, 50% PrEP coverage of high risk uninfected persons, 50% reduction in persons who never test for HIV, and 50% ART coverage over and above persons already receiving ART at baseline, could prevent 33.9% of infections over 5 years (95% confidence interval, 31.5, 36.3). The package components with the largest incremental prevention effects were UAI reduction and PrEP coverage. The impact of increased HIV testing was magnified in the presence of PrEP. We find that HIV prevention packages that include both behavioral and biomedical components can in combination prevent significant numbers of infections with levels of coverage, acceptance and adherence that are potentially achievable among MSM in South Africa.en_ZA
dc.identifier.apacitationBrookmeyer, R., Boren, D., Baral, S. D., Bekker, L. G., Phaswana-Mafuya, N., Beyrer, C., & Sullivan, P. S. (2014). Combination HIV prevention among MSM in South Africa: results from agent-based modeling. <i>PLoS One</i>, http://hdl.handle.net/11427/15290en_ZA
dc.identifier.chicagocitationBrookmeyer, Ron, David Boren, Stefan D Baral, Linda- Gail Bekker, Nancy Phaswana-Mafuya, Chris Beyrer, and Patrick S Sullivan "Combination HIV prevention among MSM in South Africa: results from agent-based modeling." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/15290en_ZA
dc.identifier.citationBrookmeyer, R., Boren, D., Baral, S. D., Bekker, L. G., Phaswana-Mafuya, N., Beyrer, C., & Sullivan, P. S. (2013). Combination HIV prevention among MSM in South Africa: results from agent-based modeling. PloS one, 9(11), e112668. doi:10.1371/journal.pone.0112668en_ZA
dc.identifier.ris TY - Journal Article AU - Brookmeyer, Ron AU - Boren, David AU - Baral, Stefan D AU - Bekker, Linda- Gail AU - Phaswana-Mafuya, Nancy AU - Beyrer, Chris AU - Sullivan, Patrick S AB - HIV prevention trials have demonstrated the effectiveness of a number of behavioral and biomedical interventions. HIV prevention packages are combinations of interventions and offer potential to significantly increase the effectiveness of any single intervention. Estimates of the effectiveness of prevention packages are important for guiding the development of prevention strategies and for characterizing effect sizes before embarking on large scale trials. Unfortunately, most research to date has focused on testing single interventions rather than HIV prevention packages. Here we report the results from agent-based modeling of the effectiveness of HIV prevention packages for men who have sex with men (MSM) in South Africa. We consider packages consisting of four components: antiretroviral therapy for HIV infected persons with CD4 count <350; PrEP for high risk uninfected persons; behavioral interventions to reduce rates of unprotected anal intercourse (UAI); and campaigns to increase HIV testing. We considered 163 HIV prevention packages corresponding to different intensity levels of the four components. We performed 2252 simulation runs of our agent-based model to evaluate those packages. We found that a four component package consisting of a 15% reduction in the rate of UAI, 50% PrEP coverage of high risk uninfected persons, 50% reduction in persons who never test for HIV, and 50% ART coverage over and above persons already receiving ART at baseline, could prevent 33.9% of infections over 5 years (95% confidence interval, 31.5, 36.3). The package components with the largest incremental prevention effects were UAI reduction and PrEP coverage. The impact of increased HIV testing was magnified in the presence of PrEP. We find that HIV prevention packages that include both behavioral and biomedical components can in combination prevent significant numbers of infections with levels of coverage, acceptance and adherence that are potentially achievable among MSM in South Africa. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0112668 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Combination HIV prevention among MSM in South Africa: results from agent-based modeling TI - Combination HIV prevention among MSM in South Africa: results from agent-based modeling UR - http://hdl.handle.net/11427/15290 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15290
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0112668
dc.identifier.vancouvercitationBrookmeyer R, Boren D, Baral SD, Bekker LG, Phaswana-Mafuya N, Beyrer C, et al. Combination HIV prevention among MSM in South Africa: results from agent-based modeling. PLoS One. 2014; http://hdl.handle.net/11427/15290.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2014 Brookmeyer et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHIV preventionen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherAgent-based modelingen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherMen who have sex with menen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleCombination HIV prevention among MSM in South Africa: results from agent-based modelingen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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