title: Can the Heterosexual HIV Epidemic be Eliminated in South Africa Using Combination Prevention? A Modeling Analysis.
abstract: Little is known about how combining efficacious interventions for human immunodeficiency virus (HIV) prevention could lead to HIV elimination. We used an agent-based simulation model, the HIV calibrated dynamic model, to assess the potential for HIV elimination in South Africa. We examined several scenarios (from continuation of the current status quo to perfect achievement of targets) with differing combinations of male condom use, adult male circumcision, HIV testing, and early antiretroviral therapy (ART). We varied numerous parameters, including the proportion of adult males circumcised, the frequency of condom use during sex acts, acceptance of HIV testing, linkage to health care, criteria for ART initiation, ART viral suppression rates, and loss to follow-up. Maintaining current levels of combination prevention would lead to increasing HIV incidence and prevalence in South Africa, while the perfect combination scenario was projected to eliminate HIV on a 50-year time scale from 2013 to 2063. Perfecting testing and treatment, without changing condom use or circumcision rates, resulted in an 89% reduction in HIV incidence but not elimination. Universal adult male circumcision alone resulted in a 21% incidence reduction within 20 years. Substantial decreases in HIV incidence are possible from sufficient uptake of both primary prevention and ART, but with continuation of the status quo, HIV elimination in South Africa is unlikely within a 50-year time scale.
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Abuelezam
authors.forename: Alethea W
authors.initials: AW
authors.lastname: McCormick
authors.forename: Thomas
authors.initials: T
authors.lastname: Fussell
authors.forename: Abena N
authors.initials: AN
authors.lastname: Afriyie
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Victor
authors.initials: V
authors.lastname: DeGruttola
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Marc
authors.initials: M
authors.lastname: Lipsitch
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
mesh_terms: D015492:AIDS Serodiagnosis / Q000592:standards* / Q000706:statistics & numerical data; D000328:Adult; D019380:Anti-HIV Agents / Q000592:standards / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods / Q000592:standards; D002944:Circumcision, Male / Q000592:standards* / Q000706:statistics & numerical data; D003198:Computer Simulation; D017280:Condoms / Q000706:statistics & numerical data*; D060740:Disease Eradication / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D015994:Incidence; D008297:Male; D008954:Models, Biological; D015995:Prevalence; D011322:Primary Prevention / Q000379:methods* / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; South Africa; acquired immunodeficiency syndrome; agent-based models; human immunodeficiency virus; mathematical modeling