The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines

Introduction: The HIV Modes of Transmission (MOT) model estimates the annual fraction of new HIV infections (FNI) acquired by different risk groups. It was designed to guide country-specific HIV prevention policies. To determine if the MOT produced context-specific recommendations, we analyzed MOT results by region and epidemic type, and explored the factors (e.g. data used to estimate parameter inputs, adherence to guidelines) influencing the differences. Methods: We systematically searched MEDLINE, EMBASE and UNAIDS reports, and contacted UNAIDS country directors for published MOT results from MOT inception (2003) to 25 September 2012. Results: We retrieved four journal articles and 20 UNAIDS reports covering 29 countries. In 13 countries, the largest FNI (range 26 to 63%) was acquired by the low-risk group and increased with low-risk population size. The FNI among female sex workers (FSWs) remained low (median 1.3%, range 0.04 to 14.4%), with little variability by region and epidemic type despite variability in sexual behaviour. In India and Thailand, where FSWs play an important role in transmission, the FNI among FSWs was 2 and 4%, respectively. In contrast, the FNI among men who have sex with men (MSM) varied across regions (range 0.1 to 89%) and increased with MSM population size. The FNI among people who inject drugs (PWID, range 0 to 82%) was largest in early-phase epidemics with low overall HIV prevalence. Most MOT studies were conducted and reported as per guidelines but data quality remains an issue. Conclusions: Although countries are generally performing the MOT as per guidelines, there is little variation in the FNI (except among MSM and PWID) by region and epidemic type. Homogeneity in MOT FNI for FSWs, clients and low-risk groups may limit the utility of MOT for guiding country-specific interventions in heterosexual HIV epidemics

Embracing different approaches to estimating HIV incidence, prevalence and mortality

Background: Joint United Nations Programme on HIV/AIDS (UNAIDS) and Murray et al. have both produced sets of estimates for worldwide HIV incidence, prevalence and mortality. Understanding differences in these estimates can strengthen the interpretation of each

The road to eliminate mother‐to‐child HIV transmission

Viaplana, AlbertPrimer pla de la plaça Lesseps en obres. En el procés de deconstrucció, una grua alça la biga 1, llosa 6 del costat Besòs de la plaça

A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster-randomised trial

The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets require that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART), and 90% of individuals on ART have durable viral suppression. The HPTN 071 (PopART) trial is measuring the impact of a universal testing and treatment intervention on population-level HIV incidence in 21 urban communities in Zambia and South Africa. We report observational data from four communities in Zambia to assess progress towards the UNAIDS targets after 1 y of the PopART intervention

HIV, Stigma, and Rates of Infection: A Rumour without Evidence

The modern concept of a social stigma comes from the work of American sociologist Erving Goffman, who described it as a response to a deeply discrediting attribute that devalues the person [1]. In the medical literature, stigma is almost inevitably written about in terms of adverse social sequelae of a disease—such as leprosy, tuberculosis, epilepsy, schizophrenia, or filariasis [2–6]—or a physical characteristic or functional loss, such as obesity, deafness, or paraplegia [7–9]. The consequences of stigma range from moderate opprobrium at one end of the spectrum to death [10]

Greater involvement of people living with HIV in health care

Greater Involvement of People Living with HIV/AIDS represents a mobilising and an organising principle for the involvement of people living with HIV in program and policy responses. People with HIV have been at the forefront of designing and implementing effective HIV treatment, care and prevention activities. However, governments and health systems have yet to act to fully harness the potential and resources of people living with HIV in addressing the epidemic

Probabilistic projections of HIV prevalence using Bayesian melding

The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed the Estimation and Projection Package (EPP) for making national estimates and short-term projections of HIV prevalence based on observed prevalence trends at antenatal clinics. Assessing the uncertainty about its estimates and projections is important for informed policy decision making, and we propose the use of Bayesian melding for this purpose. Prevalence data and other information about the EPP model's input parameters are used to derive a probabilistic HIV prevalence projection, namely a probability distribution over a set of future prevalence trajectories. We relate antenatal clinic prevalence to population prevalence and account for variability between clinics using a random effects model. Predictive intervals for clinic prevalence are derived for checking the model. We discuss predictions given by the EPP model and the results of the Bayesian melding procedure for Uganda, where prevalence peaked at around 28% in 1990; the 95% prediction interval for 2010 ranges from 2% to 7%.Comment: Published at http://dx.doi.org/10.1214/07-AOAS111 in the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

HIV epidemic types and customized prevention responses.

Since the first reported case of AIDS 27 years ago, more than 70 million people have been infected with HIV worldwide, and 25 million have died of AIDS. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 33 million people are currently living with HIV. The global prevalence of HIV has leveled off, but the total number of people living with HIV continues to grow.1 This article briefly discusses the roles that different HIV transmission modes play in the worldwide pandemic, and explains how the global pandemic is actually a complex mosaic of dynamic epidemics within and between countries.2 Further, it discusses matching appropriate prevention responses to two different types of epidemics: generalized and concentrated