A Complex Systems Approach to Evaluate HIV Prevention in Metropolitan Areas: Preliminary Implications for Combination Intervention StrategiesReportar como inadecuado




A Complex Systems Approach to Evaluate HIV Prevention in Metropolitan Areas: Preliminary Implications for Combination Intervention Strategies - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

HIV transmission among injecting and non-injecting drug users IDU, NIDU is a significant public health problem. Continuing propagation in endemic settings and emerging regional outbreaks have indicated the need for comprehensive and coordinated HIV prevention. We describe the development of a conceptual framework and calibration of an agent-based model ABM to examine how combinations of interventions may reduce and potentially eliminate HIV transmission among drug-using populations.

Methodology-Principal Findings

A multidisciplinary team of researchers from epidemiology, sociology, geography, and mathematics developed a conceptual framework based on prior ethnographic and epidemiologic research. An ABM was constructed and calibrated through an iterative design and verification process. In the model -agents- represent IDU, NIDU, and non-drug users who interact with each other and within risk networks, engaging in sexual and, for IDUs, injection-related risk behavior over time. Agents also interact with simulated HIV prevention interventions e.g., syringe exchange programs, substance abuse treatment, HIV testing and initiate antiretroviral treatment ART in a stochastic manner. The model was constructed to represent the New York metropolitan statistical area MSA population, and calibrated by comparing output trajectories for various outcomes e.g., IDU-NIDU prevalence, HIV prevalence and incidence against previously validated MSA-level data. The model closely approximated HIV trajectories in IDU and NIDU observed in New York City between 1992 and 2002, including a linear decrease in HIV prevalence among IDUs. Exploratory results are consistent with empirical studies demonstrating that the effectiveness of a combination of interventions, including syringe exchange expansion and ART provision, dramatically reduced HIV prevalence among IDUs during this time period.

Conclusions-Significance

Complex systems models of adaptive HIV transmission dynamics can be used to identify potential collective benefits of hypothetical combination prevention interventions. Future work will seek to inform novel strategies that may lead to more effective and equitable HIV prevention strategies for drug-using populations.



Autor: Brandon D. L. Marshall , Magdalena M. Paczkowski, Lars Seemann, Barbara Tempalski, Enrique R. Pouget, Sandro Galea, Samuel R. Fri

Fuente: http://plos.srce.hr/



DESCARGAR PDF




Documentos relacionados