title: Using geospatial modelling to optimize the rollout of antiretroviral-based pre-exposure HIV interventions in Sub-Saharan Africa.
abstract: Antiretroviral (ARV)-based pre-exposure HIV interventions may soon be rolled out in resource-constrained Sub-Saharan African countries, but rollout plans have yet to be designed. Here we use geospatial modelling and optimization techniques to compare two rollout plans for ARV-based microbicides in South Africa: a utilitarian plan that minimizes incidence by using geographic targeting, and an egalitarian plan that maximizes geographic equity in access to interventions. We find significant geographic variation in the efficiency of interventions in reducing HIV transmission, and that efficiency increases disproportionately with increasing incidence. The utilitarian plan would result in considerable geographic inequity in access to interventions, but (by exploiting geographic variation in incidence) could prevent ~40% more infections than the egalitarian plan. Our results show that the geographic resource allocation decisions made at the beginning of a rollout, and the location where the rollout is initiated, will be crucial in determining the success of interventions in reducing HIV epidemics.
authors.affiliation: Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gerberry
authors.affiliation: Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Wagner
authors.affiliation: Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA.
authors.forename: J Gerardo
authors.initials: JG
authors.lastname: Garcia-Lerma
authors.affiliation: Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30329, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Heneine
authors.affiliation: Center for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Blower
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D015276:Health Care Rationing / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008962:Models, Theoretical; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D015995:Prevalence; D017678:Sex Distribution
chemical_list: D044966:Anti-Retroviral Agents