Background HIV expansion is controlled by a range of interrelated factors,including the natural history of HIV infection and socio-economical and structural factors.However,how they dynamically interact in particular ...Background HIV expansion is controlled by a range of interrelated factors,including the natural history of HIV infection and socio-economical and structural factors.However,how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood.We aim to explore these mechanisms,using Madagascar as a case-study.Methods We developed a compartmental dynamic model using available data from Madagascar,a country with a contrasting concentrated epidemic,to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers.Results The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022,and prevalence reaching stabilization by 2033 within 9 to 24%in the studied(10 out of 11)cities,similar to high-prevalence regions in Southern Africa.The late/slow introduction of HIV and circumcision,a widespread traditional practice in Madagascar,could have slowed down HIV propagation,but,given the key interplay between risky behaviors associated to young women and acute infections prevalence,mediated by transactional sex,the protective efect of circumcision is currently insufcient to contain the expansion of the disease in Madagascar.Conclusions These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic.This case-study model could help to understand how this HIV epidemic transition occurs.展开更多
基金funded by the Spanish Ministerio de Ciencia e Innovacion and the European Regional Development Fund(ERDF)under the project CRISIS(PGC2018-096577-B-I00 and PRIORITY(PID2021-127202NB-C22)from the Spanish government.to D.A.)supported by the non-governmental organization(NGO)Medecins du Monde(France)and was funded by Expertise France(EF)(Initiative 5%,ref.num.16SANIN208).
文摘Background HIV expansion is controlled by a range of interrelated factors,including the natural history of HIV infection and socio-economical and structural factors.However,how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood.We aim to explore these mechanisms,using Madagascar as a case-study.Methods We developed a compartmental dynamic model using available data from Madagascar,a country with a contrasting concentrated epidemic,to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers.Results The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022,and prevalence reaching stabilization by 2033 within 9 to 24%in the studied(10 out of 11)cities,similar to high-prevalence regions in Southern Africa.The late/slow introduction of HIV and circumcision,a widespread traditional practice in Madagascar,could have slowed down HIV propagation,but,given the key interplay between risky behaviors associated to young women and acute infections prevalence,mediated by transactional sex,the protective efect of circumcision is currently insufcient to contain the expansion of the disease in Madagascar.Conclusions These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic.This case-study model could help to understand how this HIV epidemic transition occurs.
