This page provides access to all research articles developed by the HIV Modelling Consortium, in addition to meeting reports and relevant reading.
A Side Door Into Care Cascade for HIV-Infected Patients?Abstract:Download PDF: A_Side_Door_Into_Care_Cascade_for_HIV_Infected.20.pdf
: HIV Prevention Trials Network studies are testing a number of new technologies for preventing HIV infections and reducing AIDS morbidity and mortality, but strengthening existing antiretroviral therapy (ART) programs may be among the most promising ways to generate greater health benefits using available resources. A cascade to care for HIV-positive patients has been described-HIV testing, retention in pre-ART care, treatment initiation, and sustained suppression on ART-and it has been noted that many patients are lost at each stage. We constructed a detailed representation by combining data from different sources about each stage. We found that, although currently available data were not sufficient to specify several key aspects, the traditional model of the cascade could not fully reconcile trends in HIV testing, linkage to care, retention in pre-ART care, and retention on ART with the large numbers of persons on ART and the large percentage of patients initiating treatment at late stages of infection. We hypothesize that supplementing the traditional linear cascade model with patient health-seeking behaviors that allow patients who are not in pre-ART care to be initiated on ART, is essential to fully characterizing the current functioning of ART programs. We have termed this additional channel to ART as the "side door." Understanding the relative roles of the different channels to care will be important to intervening effectively to improve the cascade to care, and we propose several new types of data that should be collected. With these insights, it may be possible to considerably strengthen the impact of ART programs.
Biology as population dynamics: heuristics for transmission risk.Abstract:Download PDF: Keebler_Welte_Biology as pop dynam.pdf
Population-type models, accounting for phenomena such as population lifetimes, mixing patterns, recruitment patterns, genetic evolution and environmental conditions, can be usefully applied to the biology of HIV infection and viral replication. A simple dynamic model can explore the effect of a vaccine-like stimulus on the mortality and infectiousness, which formally looks like fertility, of invading virions; the mortality of freshly infected cells; and the availability of target cells, all of which impact on the probability of infection. Variations on this model could capture the importance of the timing and duration of different key events in viral transmission, and hence be applied to questions of mucosal immunology. The dynamical insights and assumptions of such models are compatible with the continuum of between- and within-individual risks in sexual violence and may be helpful in making sense of the sparse data available on the association between HIV transmission and sexual violence.
Understanding the modes of transmission model of new HIV infection and its use in prevention planning.Abstract:Download PDF: case_world health bulletin.pdf
The modes of transmission model has been widely used to help decision-makers target measures for preventing human immunodeficiency virus (HIV) infection. The model estimates the number of new HIV infections that will be acquired over the ensuing year by individuals in identified risk groups in a given population using data on the size of the groups, the aggregate risk behaviour in each group, the current prevalence of HIV infection among the sexual or injecting drug partners of individuals in each group, and the probability of HIV transmission associated with different risk behaviours. The strength of the model is its simplicity, which enables data from a variety of sources to be synthesized, resulting in better characterization of HIV epidemics in some settings. However, concerns have been raised about the assumptions underlying the model structure, about limitations in the data available for deriving input parameters and about interpretation and communication of the model results. The aim of this review was to improve the use of the model by reassessing its paradigm, structure and data requirements. We identified key questions to be asked when conducting an analysis and when interpreting the model results and make recommendations for strengthening the model's application in the future.
Towards an improved investment approach for an effective response to HIV/AIDS.Abstract:10.1016/S0140-6736(11)60702-2
Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.
Strengthening The Use of Mathematical Models in Community Trials Workshop Report
HIV Modelling Consortium Initiative on Incidence Assay Characterisation Workshop Report
The Potential Impact of Treatment on HIV Incidence Workshop Report