Could the 2010 HIV outbreak in Athens, Greece have been prevented? A mathematical modeling study

Abstract

Introduction In 2009 and 2010, Athens, Greece experienced a hepatitis C virus (HCV) and a Human Immunodeficiency Virus (HIV) outbreak among People Who Inject Drugs (PWID), respectively. The HCV outbreak was not detected, while that of HIV was identified in 2011. The integrated HIV-interventions, launched in early 2012, managed to reduce directly the HIV incidence and indirectly the HCV incidence. This study aims to assess what would have been the course of the HIV outbreak and its associated economic consequences if the 2009 HCV outbreak had been detected and integrated interventions had been initiated 1- or 2-years earlier. Methods The model was calibrated to reproduce the observed HIV epidemiological and clinical parameters among PWID of Athens, Greece. We examined the effect of the 1- or 2-years earlier detection scenarios, the 1-year later detection, the non-detection scenario, and compared them to the status quo scenario. Results Cumulative HIV cases, under the status-quo scenario during 2009‐2019, were 1360 (90% Credible intervals: 290, 2470). If the HCV outbreak had been detected 1- or 2- years earlier, with immediate initiation of integrated interventions, 740 and 1110 HIV cases could be averted by 2019, respectively. Regarding the costs, if there was an efficient notification system to detect the HCV outbreak 1 or 2 years earlier, 35.2–53.2 million euros could be saved compared to the status quo by 2019. Conclusions If the HCV outbreak had been detected and promptly addressed, the HIV outbreak would have been prevented and 35.2–53.2 million euros could have been saved.

Incorporation of awareness programs into a model of the spread of HIV/AIDS among people who inject drugs

“…This could be done by dividing the individuals with HIV into asymptomatic and symptomatic individuals and treating symptomatic individuals as in Salman 20 or dividing these individuals into more classes, including those on PrEP and antiretroviral therapy as in Jing et al, 17 in order to model these treatments. There are many other papers modeling HIV interventions, including Zhang et al, 15 Babaei et al, 13 Gountas et al, 18 Des Jarlais et al, 14 4) where 𝜎, 𝜏, 𝜌, and 𝜈 are defined by Equation (14).…”

“…This could be done by dividing the individuals with HIV into asymptomatic and symptomatic individuals and treating symptomatic individuals as in Salman 20 or dividing these individuals into more classes, including those on PrEP and antiretroviral therapy as in Jing et al, 17 in order to model these treatments. There are many other papers modeling HIV interventions, including Zhang et al, 15 Babaei et al, 13 Gountas et al, 18 Des Jarlais et al, 14 and Flountzi et al 45 and these give other options for modeling HIV interventions. To our knowledge our current article makes a research contribution in that it is the first time that disease awareness programs have been applied to mathematical models of HIV among PWIDs.…”

“…These managed to lower the HIV cases. Gountas et al 18 show that if the HCV epidemic had been identified and dealt with early the HIV epidemic could have been prevented and 35.2-53.2 million euros could have been saved. Flountzi et al 19 Salman 20 discusses a model for transmission of HIV including treatment.…”

Modeling the HIV epidemic in MSM in Cyprus: Reaching only the 95-95-95 cascade of care targets fails to reduce HIV incidence by 90% in 2030

“…A discrete-time, stochastic, dynamic, individual-based model of HIV transmission and progression, and of the CoC 14 was fitted to epidemiological data from the Cypriot epidemic (Table 1). The structure of the model is shown in detail in Figure S1 in the supplementary material.…”