title: Modeling the impact on HIV incidence of combination prevention strategies among men who have sex with men in Beijing, China.
abstract: OBJECTIVE
  To project the HIV/AIDS epidemics among men who have sex with men (MSM) under different combinations of HIV testing and linkage to care (TLC) interventions including antiretroviral therapy (ART) in Beijing, China.
  
  
  METHODS
  Mathematical modeling.
  
  
  METHODS
  Using a mathematical model to fit prevalence estimates from 2000-2010, we projected trends in HIV prevalence and incidence during 2011-2020 under five scenarios: (S1) current intervention levels by averaging 2000-2010 coverage; (S2) increased ART coverage with current TLC; (S3) increased TLC/ART coverage; (S4) increased condom use; and (S5) increased TLC/ART plus increased condom use.
  
  
  RESULTS
  The basic reproduction number based upon the current level of interventions is significantly higher than 1 (R0 = 2.09; 95% confidence interval (CI), 1.83-2.35), suggesting that the HIV epidemic will continue to increase to 2020. Compared to the 2010 prevalence of 7.8%, the projected HIV prevalence in 2020 for the five prevention scenarios will be: (S1) Current coverage: 21.4% (95% CI, 9.9-31.7%); (S2) Increased ART: 19.9% (95% CI, 9.9-28.4%); (S3) Increased TLC/ART: 14.5% (95% CI, 7.0-23.8%); (S4) Increased condom use: 13.0% (95% CI, 9.8-28.4%); and (S5) Increased TLC/ART and condom use: 8.7% (95% CI, 5.4-11.5%). HIV epidemic will continue to rise (R0 > 1) for S1-S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline (R0 = 0.93) for S5.
  
  
  CONCLUSIONS
  Our transmission model suggests that Beijing MSM will have a rapidly rising HIV epidemic. Even enhanced levels of TLC/ART will not interrupt epidemic expansion, despite optimistic assumptions for coverage. Promoting condom use is a crucial component of combination interventions.
authors.affiliation: Department of Mathematics, Shanghai University, Shanghai, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Lou
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America; Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: College of Mathematics and Information Science, Shaanxi Normal University, Xi'an, Shaanxi Province, China.
authors.forename: Sanyi
authors.initials: S
authors.lastname: Tang
authors.affiliation: Department of Mathematics, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Glenn F
authors.initials: GF
authors.lastname: Webb
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Institute for AIDS/STD Prevention & Control, Beijing Municipal Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xiong
authors.initials: X
authors.lastname: He
authors.affiliation: Institute for AIDS/STD Prevention & Control, Beijing Municipal Center for Disease Control and Prevention, Beijing, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Lu
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America; Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000068476:Beijing / Q000453:epidemiology; D003140:Communicable Disease Control; D017280:Condoms; D058872:Epidemics / Q000517:prevention & control; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D006266:Health Education; D006297:Health Services Accessibility; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015995:Prevalence; D012309:Risk-Taking; D021841:Safe Sex; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents