Targeting HIV services to male migrant workers in southern Africa would not reverse generalized HIV epidemics in their home communities: a mathematical modeling analysis.
BACKGROUND
Migrant populations such as mine workers contributed to the spread of HIV in sub-Saharan Africa. We used a mathematical model to estimate the community-wide impact of targeting treatment and prevention to male migrants.


METHODS
We augmented an individual-based network model, EMOD-HIV v0.8, to include an age-dependent propensity for males to migrate. Migrants were exposed to HIV outside their home community, but continued to participate in HIV transmission in the community during periodic visits.


RESULTS
Migrant-targeted interventions would have been transformative in the 1980s to 1990s, but post-2015 impacts were more modest. When targetable migrants comprised 2% of adult males, workplace HIV prevention averted 3.5% of community-wide infections over 20 years. Targeted treatment averted 8.5% of all-cause deaths among migrants. When migrants comprised 10% of males, workplace prevention averted 16.2% of infections in the community, one-quarter of which were among migrants. Workplace prevention and treatment acted synergistically, averting 17.1% of community infections and 11.6% of deaths among migrants. These estimates do not include prevention of secondary spread of HIV or tuberculosis at the workplace.


CONCLUSIONS
Though cost-effective, targeting migrants cannot collapse generalized epidemics in their home communities. Such a strategy would only have been possible prior to the early 1990s. However, migrant-targeted interventions synergize with general-population expansion of HIV services.
Institute for Disease Modeling, Bellevue, WA, USA.
Daniel J
DJ
Klein
Institute for Disease Modeling, Bellevue, WA, USA.
Philip A
PA
Eckhoff
Institute for Disease Modeling, Bellevue, WA, USA abershteyn@intven.com.
Anna
A
Bershteyn
D017954:Africa South of the Sahara / Q000453:epidemiology; D058872:Epidemics; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006296:Health Services; D006801:Humans; D008297:Male; D008954:Models, Biological; D009786:Occupational Health Services; D012111:Residence Characteristics; D012725:Sexual Behavior; D014171:Transients and Migrants; D017132:Workplace
Epidemiology; HIV prevention; HIV/AIDS; Migration; Modeling; Southern Africa