Potential Impact of Existing Interventions and of Antiretroviral Use in Female Sex Workers on Transmission of HIV in Burkina Faso

Low, Andrea; Nagot, Nicolas; Konaté, Issouf; Méda, Nicolas; Segondy, Michel; Perre, Philippe Van de; Mayaud, Philippe; Vickerman, Peter

doi:10.1097/qai.0000000000000441

Cited by 19 publications

(25 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Côte d'Ivoire, this impact is predominantly due to the documented increases in condom use by FSW 7 , which may have prevented up to 46% of all infections. This is comparable to results of condom interventions for FSW implemented in Benin 50 and Burkina Faso 58 . Condom use among MSM had a more limited impact on overall transmission because of limited sexual mixing of MSM with the general population.…”

Section: Discussionsupporting

confidence: 73%

See 1 more Smart Citation

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Maheu‐Giroux

Vesga

Diabaté

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Introduction Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods An age stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men (MSM) was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results Overall, condom use averted 61% (95% Credible Intervals: 56-66%) of all adult infections during 1987-2015 mainly due to increases by FSW (46% of infections averted). In comparison, ART prevented 15% (10-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91-97%) of all new infections, declining to 19% (11-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributor to transmission. MSM contributed ≤4% of transmission throughout. Young women (15-24 years; excluding FSW) did not transmit more infection than they acquired. Conclusion Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSW and older men have become the main source of transmission whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and CFSW, is important.

show abstract

Section: Discussionsupporting

confidence: 73%

“…As for other epidemics driven by unprotected sex work 56,57 , commercial sex contributed markedly to HIV transmission early in the HIV epidemic. This contribution diminished with time, however, partly due to rising condom use by FSW, reflecting the importance of sustaining FSW interventions 50,58,59 .…”

Section: Discussionmentioning

confidence: 99%

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Maheu‐Giroux

Vesga

Diabaté

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

show abstract

“…Previous analyses have shown a large role for commercial sex in some sub-Saharan HIV epidemics [10][11][12][13][14], but this is the first to suggest that MSM, including individuals who identify as cis-male and TGW, could also be having an important role in some lowerand middle-income country settings, where other analyses have suggested a small role [14,15,62]. This is likely due to the different behavioural and epidemiological situation among MSM in Dakar compared to these other settings.…”

Section: Discussionmentioning

confidence: 99%

“…KPs, such that a male who becomes infected by another male could then infect a female, resulting in the initial male not only contributing to the MSM HIV epidemic but also the heterosexual epidemic. Indeed, for commercial sex, these analyses conflict with emerging dynamic modelling analyses suggesting that >90% of all HIV transmissions to date are directly or indirectly due to sex work in the low-to-moderate prevalence HIV epidemics of Burkina Faso, Cote d'Ivoire and Benin, and over 65% in the higher-prevalence HIV epidemic in Kenya [9][10][11][12][13][14]. These analyses challenge the conventional wisdom and existing epidemiological tools such as the MOT model.…”

mentioning

confidence: 99%

Estimating the contribution of key populations towards the spread ofHIVin Dakar, Senegal

et al. 2018

Self Cite

View full text Add to dashboard Cite

IntroductionKey populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF).MethodsA dynamic transmission model of HIV among FSW, their clients, MSM and the lower‐risk adult population was parameterized and calibrated within a Bayesian framework using setting‐specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10‐year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment.ResultsThe model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10‐year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two‐thirds through any prevention modality.ConclusionsUnprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence‐informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.

show abstract

“…This is reflected in the lower PAF of commercial sex and sex between men predicted after 2016, and higher PAF for regular partnerships. Other modelling studies have also suggested that the PAF for commercial sex has declined over time in West/Central Africa [37,38] and southern India [6], as condom use in commercial sex increased and greater HIV transmission occurred outside key populations.…”

Section: Discussionmentioning

confidence: 99%

Potential impact of pre‐exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study

Mitchell

Prudden

Washington

et al. 2016

Journal of the International AIDS Society

Self Cite

View full text Add to dashboard Cite

IntroductionIn Bangalore, new HIV infections of female sex workers and men who have sex with men continue to occur, despite high condom use. Pre-exposure prophylaxis (PrEP) has high anti-HIV efficacy for men who have sex with men. PrEP demonstration projects are underway amongst Indian female sex workers. We estimated the impact and efficiency of prioritizing PrEP to female sex workers and/or men who have sex with men in Bangalore.MethodsA mathematical model of HIV transmission and treatment for female sex workers, clients, men who have sex with men and low-risk groups was parameterized and fitted to Bangalore data. The proportion of transmission attributable (population attributable fraction) to commercial sex and sex between men was calculated. PrEP impact (infections averted, life-years gained) and efficiency (life-years gained/infections averted per 100 person-years on PrEP) were estimated for different levels of PrEP adherence, coverage and prioritization strategies (female sex workers, high-risk men who have sex with men, both female sex workers and high-risk men who have sex with men, or female sex workers with lower condom use), under current conditions and in a scenario with lower baseline condom use amongst key populations.ResultsPopulation attributable fractions for commercial sex and sex between men have declined over time, and they are predicted to account for 19% of all new infections between 2016 and 2025. PrEP could prevent a substantial proportion of infections amongst female sex workers and men who have sex with men in this setting (23%/27% over 5/10 years, with 60% coverage and 50% adherence), which could avert 2.9%/4.3% of infections over 5/10 years in the whole Bangalore population. Impact and efficiency in the whole population was greater if female sex workers were prioritized. Efficiency increased, but impact decreased, if only female sex workers with lower condom use were given PrEP. Greater impact and efficiency was predicted for the scenario with lower condom use.ConclusionsPrEP could be beneficial for female sex workers and men who have sex with men in Bangalore, and give some benefits in the general population, especially in similar settings with lower condom use levels.

show abstract

Potential Impact of Existing Interventions and of Antiretroviral Use in Female Sex Workers on Transmission of HIV in Burkina Faso

Cited by 19 publications

References 63 publications

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Estimating the contribution of key populations towards the spread ofHIVin Dakar, Senegal

Potential impact of pre‐exposure prophylaxis for female sex workers and men who have sex with men in Bangalore, India: a mathematical modelling study

Contact Info

Product

Resources

About