Prospects for HIV control in South Africa: a model-based analysis

The goal of virtual elimination of horizontal and mother-to-child HIV transmission in South Africa (SA) has been proposed, but there have been few systematic investigations of which interventions are likely to be most critical to reducing HIV incidence. This study aims to evaluate SA's potentia...

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Bibliographic Details
Published in:Global health action Vol. 9; no. 1; pp. 30314 - 12
Main Authors: Johnson, Leigh F., Chiu, Calvin, Myer, Landon, Davies, Mary-Ann, Dorrington, Rob E., Bekker, Linda-Gail, Boulle, Andrew, Meyer-Rath, Gesine
Format: Journal Article
Language:English
Published: United States Taylor & Francis 01.12.2016
Taylor & Francis Ltd
Co-Action Publishing
Taylor & Francis Group
Subjects:
Adult
Adults
Anti-HIV Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
Breast feeding
Breastfeeding & lactation
Child
Children
Circumcision
Correlation coefficient
Counseling
Elimination
Epidemiology
Female
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - prevention & control
HIV Infections - transmission
HIV/AIDS
Human immunodeficiency virus
Humans
Incidence
Infectious Disease Transmission, Vertical - prevention & control
Intervention
Male
Marital relations
mathematical model
Mathematical models
Medical treatment
Models, Theoretical
Mothers
Original
Patients
Pediatrics
Pregnancy
Pregnancy Complications, Infectious - drug therapy
Pregnancy Complications, Infectious - prevention & control
Prospects
Risk factors
Risk reduction
South Africa
South Africa - epidemiology
Uncertainty
Uptake
South Africa
HIV/AIDS
mathematical model
South Africa
ISSN:1654-9716, 1654-9880, 1654-9880
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Summary:The goal of virtual elimination of horizontal and mother-to-child HIV transmission in South Africa (SA) has been proposed, but there have been few systematic investigations of which interventions are likely to be most critical to reducing HIV incidence. This study aims to evaluate SA's potential to achieve virtual elimination targets and to identify which interventions will be most critical to achieving HIV incidence reductions. A mathematical model was developed to simulate the population-level impact of different HIV interventions in SA. Probability distributions were specified to represent uncertainty around 32 epidemiological parameters that could be influenced by interventions, and correlation coefficients (r) were calculated to assess the sensitivity of the adult HIV incidence rates and mother-to-child transmission rates (2015-2035) to each epidemiological parameter. HIV incidence in SA adults (ages 15-49) is expected to decline from 1.4% in 2011-2012 to 0.29% by 2035 (95% CI: 0.10-0.62%). The parameters most strongly correlated with future adult HIV incidence are the rate of viral suppression after initiating antiretroviral treatment (ART) (r=−0.56), the level of condom use in non-marital relationships (r=−0.40), the phase-in of intensified risk-reduction counselling for HIV-positive adults (r=0.29), the uptake of medical male circumcision (r=−0.24) and the phase-in of universal ART eligibility (r=0.22). The paediatric HIV parameters most strongly associated with mother-to-child transmission rates are the relative risk of transmission through breastfeeding when the mother is receiving ART (r=0.70) and the rate of ART initiation during pregnancy (r=−0.16). The virtual elimination target of a 0.1% incidence rate in adults will be difficult to achieve. Interventions that address the infectiousness of patients after ART initiation will be particularly critical to achieving long-term HIV incidence declines in South Africa.
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Responsible Editor: Peter Byass, Umeå University, Sweden.
ISSN:1654-9716
1654-9880
1654-9880
DOI:10.3402/gha.v9.30314