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Population-level impact of an accelerated HIV response plan to reach the UNAIDS 90-90-90 target in Côte d'Ivoire: Insights from mathematical modeling.

Abstract National responses will need to be markedly accelerated to achieve the ambitious target of the Joint United Nations Programme on HIV/AIDS (UNAIDS). This target aims for 90% of HIV-positive individuals to be aware of their status, for 90% of those aware to receive antiretroviral therapy (ART), and for 90% of those on treatment to have a suppressed viral load by 2020, with each individual target reaching 95% by 2030. We aimed to estimate the impact of various treatment-as-prevention scenarios in Côte d'Ivoire, one of the countries with the highest HIV incidence in West Africa, with unmet HIV prevention and treatment needs, and where key populations are important to the broader HIV epidemic.
PMID
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Authors

Mayor MeshTerms

Models, Theoretical

Sexual Behavior

Keywords
Journal Title plos medicine
Publication Year Start




PMID- 28617810
OWN - NLM
STAT- MEDLINE
DA  - 20170615
DCOM- 20170623
LR  - 20170623
IS  - 1549-1676 (Electronic)
IS  - 1549-1277 (Linking)
VI  - 14
IP  - 6
DP  - 2017 Jun
TI  - Population-level impact of an accelerated HIV response plan to reach the UNAIDS
      90-90-90 target in Cote d'Ivoire: Insights from mathematical modeling.
PG  - e1002321
LID - 10.1371/journal.pmed.1002321 [doi]
AB  - BACKGROUND: National responses will need to be markedly accelerated to achieve
      the ambitious target of the Joint United Nations Programme on HIV/AIDS (UNAIDS). 
      This target aims for 90% of HIV-positive individuals to be aware of their status,
      for 90% of those aware to receive antiretroviral therapy (ART), and for 90% of
      those on treatment to have a suppressed viral load by 2020, with each individual 
      target reaching 95% by 2030. We aimed to estimate the impact of various
      treatment-as-prevention scenarios in Cote d'Ivoire, one of the countries with the
      highest HIV incidence in West Africa, with unmet HIV prevention and treatment
      needs, and where key populations are important to the broader HIV epidemic.
      METHODS AND FINDINGS: An age-stratified dynamic model was developed and
      calibrated to epidemiological and programmatic data using a Bayesian framework.
      The model represents sexual and vertical HIV transmission in the general
      population, female sex workers (FSW), and men who have sex with men (MSM). We
      estimated the impact of scaling up interventions to reach the UNAIDS targets, as 
      well as the impact of 8 other scenarios, on HIV transmission in adults and
      children, compared to our baseline scenario that maintains 2015 rates of testing,
      ART initiation, ART discontinuation, treatment failure, and levels of condom use.
      In 2015, we estimated that 52% (95% credible intervals: 46%-58%) of HIV-positive 
      individuals were aware of their status, 72% (57%-82%) of those aware were on ART,
      and 77% (74%-79%) of those on ART were virologically suppressed. Reaching the
      UNAIDS targets on time would avert 50% (42%-60%) of new HIV infections over
      2015-2030 compared to 30% (25%-36%) if the 90-90-90 target is reached in 2025.
      Attaining the UNAIDS targets in FSW, their clients, and MSM (but not in the rest 
      of the population) would avert a similar fraction of new infections (30%;
      21%-39%). A 25-percentage-point drop in condom use from the 2015 levels among FSW
      and MSM would reduce the impact of reaching the UNAIDS targets, with 38%
      (26%-51%) of infections averted. The study's main limitation is that homogenous
      spatial coverage of interventions was assumed, and future lines of inquiry should
      examine how geographical prioritization could affect HIV transmission.
      CONCLUSIONS: Maximizing the impact of the UNAIDS targets will require rapid
      scale-up of interventions, particularly testing, ART initiation, and limiting ART
      discontinuation. Reaching clients of FSW, as well as key populations, can
      efficiently reduce transmission. Sustaining the high condom-use levels among key 
      populations should remain an important prevention pillar.
FAU - Maheu-Giroux, Mathieu
AU  - Maheu-Giroux M
AUID- ORCID: http://orcid.org/0000-0002-8363-4388
AD  - Department of Epidemiology, Biostatistics, and Occupational Health, McGill
      University, Montreal, Quebec, Canada.
FAU - Vesga, Juan F
AU  - Vesga JF
AUID- ORCID: http://orcid.org/0000-0003-1103-9587
AD  - Department of Infectious Disease Epidemiology, Imperial College London, St Mary's
      Hospital, London, United Kingdom.
FAU - Diabate, Souleymane
AU  - Diabate S
AD  - Centre de recherche du CHU de Quebec - Universite Laval, Quebec, Canada.
AD  - Departement d'infectiologie et sante publique, Universite Alassane Ouattara,
      Bouake, Cote d'Ivoire.
FAU - Alary, Michel
AU  - Alary M
AD  - Centre de recherche du CHU de Quebec - Universite Laval, Quebec, Canada.
AD  - Departement de medecine sociale et preventive, Universite Laval, Quebec, Canada.
AD  - Institut national de sante publique du Quebec, Quebec, Canada.
FAU - Baral, Stefan
AU  - Baral S
AUID- ORCID: http://orcid.org/0000-0002-5482-2419
AD  - Key Populations Program, Department of Epidemiology, Johns Hopkins Bloomberg
      School of Public Health, Baltimore, Maryland, United States of America.
FAU - Diouf, Daouda
AU  - Diouf D
AD  - Enda Sante, Dakar, Senegal.
FAU - Abo, Kouame
AU  - Abo K
AD  - Programme National de Lutte contre le SIDA, Ministere de la Sante et de l'Hygiene
      Publique, Abidjan, Cote d'Ivoire.
FAU - Boily, Marie-Claude
AU  - Boily MC
AD  - Department of Infectious Disease Epidemiology, Imperial College London, St Mary's
      Hospital, London, United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20170615
PL  - United States
TA  - PLoS Med
JT  - PLoS medicine
JID - 101231360
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Acquired Immunodeficiency Syndrome/drug therapy/prevention & control/*therapy
MH  - Adolescent
MH  - Adult
MH  - Anti-HIV Agents/*therapeutic use
MH  - Bayes Theorem
MH  - Condoms/*utilization
MH  - Cote d'Ivoire
MH  - Female
MH  - HIV Infections/drug therapy/prevention & control/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Models, Theoretical
MH  - Sex Workers
MH  - *Sexual Behavior
MH  - United Nations
MH  - Young Adult
EDAT- 2017/06/16 06:00
MHDA- 2017/06/24 06:00
CRDT- 2017/06/16 06:00
PHST- 2016/08/22 [received]
PHST- 2017/05/09 [accepted]
AID - 10.1371/journal.pmed.1002321 [doi]
AID - PMEDICINE-D-16-02716 [pii]
PST - epublish
SO  - PLoS Med. 2017 Jun 15;14(6):e1002321. doi: 10.1371/journal.pmed.1002321.
      eCollection 2017 Jun.