Romain Silhol1,2, Stefan Baral3, Anna L Bowring3,4, Christinah Mukandavire2, Iliassou M Njindam3, Amrita Rao3, Sheree Schwartz3, Ubald Tamoufe3,5, Serge C Billong6,7, Oudou Njoya8, Anne-Cecile Zoung-Kanyi Bissek8,9, Jesus M G Calleja10, Peter Vickerman11, Sharmistha Mishra12,13, Marie-Claude Boily1,2. 1. Department of Infectious Disease Epidemiology, Imperial College London, HPTN Modelling Centre, London, United Kingdom. 2. MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom. 3. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. 4. Burnet Institute, Melbourne, Australia. 5. Metabiota, Yaoundé, Cameroon. 6. Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. 7. National AIDS Control Committee (NACC/CNLS), Yaoundé, Cameroon. 8. Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. 9. Division of Operations Research, Ministry of Health, Yaoundé, Cameroon. 10. World Health Organization, Geneva, Switzerland. 11. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom. 12. St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada; and. 13. Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission. SETTING: Yaoundé, Cameroon. METHODS: We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group. RESULTS: Condom use and ART together may have averted 43% (95% uncertainty interval: 31-54) of incident infections over 1980-2018 and 72% (66-79) over 2009-2018. Most onward transmissions over 2009-2018 stemmed from sex between lower-risk individuals [47% (32-61)], clients [37% (23-51)], and MSM [35% (20-54)] with all their partners. The contribution of commercial sex decreased from 25% (8-49) over 1989-1998 to 8% (3-22) over 2009-2018, due to higher intervention coverage among FSW. CONCLUSION: Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.
BACKGROUND: Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission. SETTING: Yaoundé, Cameroon. METHODS: We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group. RESULTS: Condom use and ART together may have averted 43% (95% uncertainty interval: 31-54) of incident infections over 1980-2018 and 72% (66-79) over 2009-2018. Most onward transmissions over 2009-2018 stemmed from sex between lower-risk individuals [47% (32-61)], clients [37% (23-51)], and MSM [35% (20-54)] with all their partners. The contribution of commercial sex decreased from 25% (8-49) over 1989-1998 to 8% (3-22) over 2009-2018, due to higher intervention coverage among FSW. CONCLUSION: Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.
Authors: Meghan C DiCarlo; Gina A Dallabetta; Chris Akolo; Sergio Bautista-Arredondo; H Victor Digolo; Virginia A Fonner; Grace Jill Kumwenda; Patrick Mbulaje; Peninah W Mwangi; Navindra E Persuad; Simon Sikwese; Tisha A Wheeler; R Cameron Wolf; Hally R Mahler Journal: J Int AIDS Soc Date: 2022-07 Impact factor: 6.707
Authors: Marc d'Elbée; Métogara Mohamed Traore; Kéba Badiane; Anthony Vautier; Arlette Simo Fotso; Odé Kanku Kabemba; Nicolas Rouveau; Peter Godfrey-Faussett; Mathieu Maheu-Giroux; Marie-Claude Boily; Graham Francis Medley; Joseph Larmarange; Fern Terris-Prestholt Journal: Front Public Health Date: 2021-05-24