Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya: a modelling study

Abstract

BackgroundMultiple 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).MethodsA 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.ResultsAfter 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 %.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1520-4) contains supplementary material, which is available to authorized users.

Implementation of pre‐exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy

“…Another modelling study [6] investigating the introduction of PrEP among women in Western Kenya found that it could have a substantial impact on incidence (22–28% reduction over four years) if implemented alone and that in combination with increased voluntary medical male circumcision and the implementation of 2013 WHO ART guidelines it could reduce incidence by 46–67%, but cost-effectiveness was not evaluated. Cremin and Hallet [7] used Nyanza, Kenya, as a case study to investigate PrEP intervention efficiencies associated with longer residual protection and changes in cost, adherence and prioritization as a function of coverage and time.…”

The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships

“…Kenya, along with other sub-Saharan African countries, has made tremendous strides in the delivery of antiretroviral therapy (ART) to HIV-infected persons (Blaizot et al, 2016; Kelly & Wilson, 2015; Odhiambo, Kellogg, & Kim, 2014). ART coverage in Kenya increased from 64% in 2008 to 80% in 2013 (NACC, 2014).…”

Decreased risk of HIV‐associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population‐based analysis

“…ART coverage increased from 22.0% ( n = 7766) in 2009, to 55.7% ( n = 20 139) in 2014 (study data), and to 82.7% in 2016 . ART coverage was similar for both gender in 2011 (men: 36.7%; women: 35.6%) , but point estimates tended to be higher for women in 2016 (men: 79.1%; women: 84.1%) . During the first year of TB decline in 2010, ART coverage was between 22.0% and 29.9%.…”

“…To obtain stratified denominators of PLHIV, sex‐ and age‐stratified population data were multiplied by the corresponding regional HIV prevalence estimates. Because regional stratified HIV prevalence estimates were not available from a single source, we used the 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) estimates for the 20‐ to 49‐year‐olds, the 2006–2007 Demographic and Health Survey (DHS) estimates for the ≤14‐ and ≥50‐year‐olds, and averaged SHIMS and DHS prevalence estimates for the 15‐ to 19‐year‐olds. Finally, the stratified mid‐year numbers of patients active on ART were divided by the corresponding stratified population estimates of PLHIV to obtain sex‐ and age‐stratified ART coverage estimates.…”

“…Finally, we plotted trends in TB notifications and ART coverage between 2008 and 2016. To complement missing information, the national TB programme annual report provided the 2008 regional TB notification estimate, and the first and second Swaziland HIV Incidence Measurement Surveys provided the regional 2011 and regional 2016 ART coverage estimates overall and separately for men and women.…”