Decreasing HIV transmissions to African American women through interventions for men living with HIV post-incarceration: An agent-based modeling study

Abstract

Background Incarceration and HIV disproportionately impact African American communities. The mass incarceration of African American men is hypothesized to increase HIV acquisition risk for African American women. Interventions optimizing HIV care engagement and minimizing sexual risk behaviors for men living with HIV post-incarceration may decrease HIV incidence. Methods Using an agent-based model, we simulated a sexual and injection drug using network representing the African American population of Philadelphia. We compared intervention strategies for men living with HIV post-incarceration by the number of averted HIV transmissions to women within the community. Three interventions were evaluated: a 90-90-90 scenario scaling up HIV testing, ART provision, and ART adherence; a behavioral intervention decreasing sexual risk behaviors; and a combination intervention involving both. Results The status quo scenario projected 2,836 HIV transmissions to women over twenty years. HIV transmissions to women decreased by 29% with the 90-90-90 intervention, 23% with the behavioral intervention, and 37% with both. The number of men living with HIV receiving the intervention needed in order to prevent a single HIV transmission ranged between 6 and 10. Conclusion Interventions to improve care engagement and decrease sexual risk behaviors post-incarceration for men living with HIV have the potential to decrease HIV incidence within African American heterosexual networks.

The Application of Systems Thinking to the Prevention and Control of Sexually Transmissible Infections among Adolescents and Adults: A Scoping Review

“…Generally, studies examined STI prevention and control in the population at large; exceptions to this were studies concerned with people living with HIV (n = 22) [5,9,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53], people who inject drugs (n = 5) [54][55][56][57][58], women (n = 16) [5,11,[59][60][61][62][63][64][65][66][67][68][69][70][71][72], children and young people (n = 11) [43,49,57,[72][73][74][75]…”

“…Other systems thinking methods included network analysis, which was used in ten studies to understand program reach [75,82], or the transmission of HIV and other STIs within defined social and sexual networks [36,39,[54][55][56]60,80,81]. Agent-based modelling was expressly mentioned in four studies as a method for understanding interactions between people who inject drugs and other individuals [56], incarcerated men and their female sexual partners [59,60], and young people living with HIV and HIV service providers [43]. Scenario technique/planning was used in two studies [76,94].…”

“…,[51][52][53]55,58,60,61,63,67,72,84,85,[92][93][94][95][96][97][98]. Applications of the method included understanding how:…”

Agent-based model projections for reducing HIV infection among MSM: Prevention and care pathways to end the HIV epidemic in Chicago, Illinois

“…Most HIV-related ABMs have been used to conduct virtual experiments of the impact of various interventions [ 29 , 31 , 39 , 40 ]. These interventions, like all interventions in propagating phenomena, can be classified into targeting 1 of the 3 sub-processes of propagation [ 41 ]: radiation, transmission, and reception.…”

Qualitative Study of African-American Women’s Intergenerational Dialogue for HIV Prevention

“…However, those traditional preventive strategies have not been effectively tailored to meet the needs for AA women (Adams et al, 2019; El-Bassel et al, 2009; Kennedy & Jenkins, 2011). Thus, identifying new strategies that consider the life context, unique strengths, and stressors within AA communities may help to minimize sexual risk behaviors.…”