title: Predicting trends in HIV-1 sexual transmission in sub-Saharan Africa through the Drug Resource Enhancement Against AIDS and Malnutrition model: antiretrovirals for 5 reduction of population infectivity, incidence and prevalence at the district level.
abstract: BACKGROUND
  The use of antiretrovirals to reduce the incidence of human immunodeficiency virus (HIV) infection has been evaluated in mathematical models as potential strategies for curtailing the epidemic. Cohort data from the Drug Resource Enhancement Against AIDS and Malnutrition (DREAM) Program was used to generate a realistic model for the HIV epidemic in sub-Saharan Africa.
  
  
  METHODS
  Two combined stochastic models were developed: patient and epidemic models. Models were combined using virus load as a parameter of infectivity. DREAM data that assessed patient care in Mozambique and Malawi were used to generate measures of infectivity, survival, and adherence. The Markov chain prediction model was used for the analysis of disease progression in treated and untreated patients. A partnership model was used to assess the probability that an infected individual would transmit HIV.
  
  
  RESULTS
  Data from 26565 patients followed up from January 2002 through July 2009 were analyzed with the model; 63% of patients were female, the median age was 35 years, and the median observation time was 25 months. In the model, a 5-fold reduction in infectivity (from 1.6% to 0.3%) occurred within 3 years when triple ART was used. The annual incidence of HIV infection declined from 7% to 2% in 2 years, and the prevalence was halved, from 12% to 6%, in 11 years. Mortality in HIV-infected individuals declined by 50% in 5 years. A cost analysis demonstrated economic efficiency after 4 years.
  
  
  CONCLUSIONS
  Our model, based on patient data, supports the hypothesis that treatment of all infected individuals translates into a drastic reduction in incident HIV infections. A targeted implementation strategy with massive population coverage is feasible in sub-Saharan Africa.
authors.affiliation: Department of Epidemiology and Public Health, Tor Vergata University, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Bernava
authors.forename: Andrea
authors.initials: A
authors.lastname: Nucita
authors.forename: Pietro
authors.initials: P
authors.lastname: Giglio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liotta
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen-Saines
authors.forename: Stefano
authors.initials: S
authors.lastname: Orlando
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancinelli
authors.forename: Ersilia
authors.initials: E
authors.lastname: Buonomo
authors.forename: Paola
authors.initials: P
authors.lastname: Scarcella
authors.forename: Anna Maria Doro
authors.initials: AM
authors.lastname: Altan
authors.forename: Gianni
authors.initials: G
authors.lastname: Guidotti
authors.forename: Susanna
authors.initials: S
authors.lastname: Ceffa
authors.forename: Jere
authors.initials: J
authors.lastname: Haswell
authors.forename: Ines
authors.initials: I
authors.lastname: Zimba
authors.forename: Nurja Abdul
authors.initials: NA
authors.lastname: Magid
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009073:Mozambique / Q000453:epidemiology; D015995:Prevalence; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents