title: Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya: a modelling study.
abstract: BACKGROUND
  Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya).
  
  
  METHODS
  A mathematical model was used with data on adults (15-59 years) from the Ndhiwa HIV Impact in Population Survey to compare the impacts on HIV prevalence, HIV incidence rate, and population viral load suppression of various interventions. These interventions included: improving the cascade of care (use of three guidelines), increasing voluntary medical male circumcision (VMMC), and implementing pre-exposure prophylaxis (PrEP) use among HIV-uninfected women.
  
  
  RESULTS
  After four years, improving separately the cascade of care under the WHO 2013 guidelines and under the treat-all strategy would reduce the overall HIV incidence rate by 46 and 58 %, respectively, vs. the baseline rate, and by 35 and 49 %, respectively, vs. the implementation of the current Kenyan guidelines. With conservative and optimistic scenarios, VMMC and PrEP would reduce the HIV incidence rate by 15-25 % and 22-28 % vs. the baseline, respectively. Combining the WHO 2013 guidelines with VMMC would reduce the HIV incidence rate by 35-56 % and combining the treat-all strategy with VMMC would reduce it by 49-65 %. Combining the WHO 2013 guidelines, VMMC, and PrEP would reduce the HIV incidence rate by 46-67 %.
  
  
  CONCLUSIONS
  The impacts of the WHO 2013 guidelines and the treat-all strategy were relatively close; their implementation is desirable to reduce HIV spread. Combining several strategies is promising in adult populations of hyperendemic areas but requires regular, reliable, and costly monitoring.
authors.affiliation: Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France. stephanie.blaizot@chu-lyon.fr.|Université de Lyon, F-69000, Lyon, France. stephanie.blaizot@chu-lyon.fr.|Université Lyon 1, F-69100, Villeurbanne, France. stephanie.blaizot@chu-lyon.fr.|CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100, Villeurbanne, France. stephanie.blaizot@chu-lyon.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Blaizot
authors.affiliation: Epicentre, F-75011, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Maman
authors.affiliation: Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France.|Université de Lyon, F-69000, Lyon, France.|Université Lyon 1, F-69100, Villeurbanne, France.|CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100, Villeurbanne, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Riche
authors.affiliation: National AIDS and STDs Control Program, Nairobi, Kenya.
authors.forename: Irene
authors.initials: I
authors.lastname: Mukui
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kirubi
authors.affiliation: Service de Biostatistique, Hospices Civils de Lyon, F-69003, Lyon, France.|Université de Lyon, F-69000, Lyon, France.|Université Lyon 1, F-69100, Villeurbanne, France.|CNRS UMR 5558, Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Evolutive, F-69100, Villeurbanne, France.
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.affiliation: Epicentre, F-75011, Paris, France.|UMI 233 TransVIHMI, Institut de Recherche pour le Développement, Université Montpellier 1, F-34000, Montpellier, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D019562:Viral Load; D055815:Young Adult
keywords: Antiretroviral therapy; HIV; Hyperendemic settings; Male circumcision; Mathematical models; Pre-exposure prophylaxis